ARTICLES & RESOURCES
Your revenue leaks at multiple stages in the entire claims processing cycle. MGMA’s January 2026 poll revealed that denials and appeals account for as much as 48% of revenue cycle leaks, while front-end issues account 23%. That means you’re losing revenue on claims for which you’ve already delivered care. Here, we’ll cover where you’re losing
Timely reimbursement starts with accurate point-of-care documentation. Here’s where documentation issues begin and how they impact your reimbursement. Key Takeaways Inaccurate and incomplete documentation directly affects your reimbursement and creates staff rework. Clear administrative roles catch issues before claims are submitted. AI, machine learning and delegation help surface missing details earlier and reduce manual corrections
Let’s say a QA reviewer flags missing OASIS discharge items after the visit has already been closed. The claim is pushed back by two weeks, even if the patient care has already been delivered. This happens when documentation is finalized before required discharge elements are fully captured in the workflow. This guide breaks down where
Let’s say two agencies have the same census, payer mix and staffing. One gets flagged for documentation gaps across six patients. The other walks out clean. The difference was that one of them was catching them internally, every week, before a surveyor did. Quality Assurance and Performance Improvement (QAPI) is the system CMS requires every
You lose clean claims not because of your patient care quality, but because of unclear, inconsistent documentation. Vague narratives, miscoded diagnoses and missed time points slow reimbursement and put your agency at risk with CMS reviewers. This article shows a sample OASIS assessment form and how to structure it for compliant, payable documentation. Key Takeaways
Getting an additional documentation request or ADR notice can feel like an audit threat, but it’s not. An ADR is a documentation request, and how your team responds in the next 45 days determines whether you get paid. This guide breaks down what ADRs are, what triggers them and how to build a response process
A 2024 CMS report showed that 51.4% of improper payments in home health services trace back to insufficient documentation. Most agencies fix the wrong end of the problem. They pressure the billing staff when the breakdown started at intake, in the visit note or at the coder’s desk. This guide breaks down where revenue gets
Every denied claim costs you twice, once in revenue and in the staff rework that follows. The good news: most denials are preventable with accurate and efficient home health billing. Agencies that bring in outsourced billing support protect revenue and free their teams to focus on exceptional patient care. Key Takeaways Accurate documentation, proper coding
In 2024, CMS reported that 6% to 8% of Medicare Fee-for-Service claims had errors, including incomplete documentation and OASIS gaps. Stronger OASIS processes help protect reimbursement, reduce audit risk and give your team more time to focus on patient care. Key Takeaways Minor mistakes in OASIS coding or patient records can trigger ADRs and slow
Excellent patient care is not always equal to better revenue. According to Practolytics, nearly one in five home health claims is denied on the first submission, and 40% of those stem from missing documentation. This guide shows how to cut denied claims and maintain a steady cash flow, leaving more time for patient care. Key