Home Care & LTC Pain Points and Solutions

A client authorized for 40 hours gets 32 because one shift never got filled, and 104 approved hours lapse a quarter. Here is why authorized hours go unbilled.

Delivered visits keep pending because clock-in times do not match the aggregator and nobody works the mismatch queue daily. Here is why, and how to clear it.

One held March claim blocks April, May, and June, and a mistyped date breaks the chain. Here is why hospice sequential billing keeps landing in RTP.

A patient revokes Friday, billing hears Tuesday, and the five-day NOTR window is gone. Here is why the handoff fails and how to file every notice on time.

Packets get signed in the field under pressure, and nobody re-reads the election against the CMS checklist before billing. Here is how a QA step fixes it.

An auditor approves one GIP claim in six and recodes the rest because the notes never justify inpatient care. Here is how daily review defends the days.

One MCO sits on clean claims for 75 days while payroll runs weekly and you borrow to cover the gap. Track days-to-payment by payer and escalate prompt-pay.

You bill a resident’s son under a responsible-party clause, he cites the federal ban on third-party guarantees, and the account is written off. Here is the fix.

An OIG report found MA plans overturned 95 percent of appealed SNF denials. Here is why short-staffed case management accepts denials it would win.

Your SNF claim keeps rejecting because another provider never final-billed its episode. Here is why cross-setting overlaps block your clean claim, and who works them.

A completed SOC can sit days in OASIS review before it bills, and a third of a month of revenue lives in that queue. Here is what the lag costs and how to shrink it.

The care was delivered, yet the LTC carrier pends three months of pay over a note mismatch. Here is why LTC claims stall on paperwork, and how to get them paid.

A No-EVV denial means the payer never got EVV data for your claim. Here is why HHAeXchange claims earn one and how a pre-bill check stops them before they go out.

A deleted Face to Face document quietly stops a WellSky episode from billing, with no alert. Here is how to catch the silent drop before claims disappear.

When EVV transactions fail, visits keep happening but Medicaid will not pay without a verified-visit trail. Here is what to do during the outage.

Your PointClickCare setup is clean, yet PDPM scores come in low and A/R never clears. Here is why MDS coding gaps suppress SNF revenue, and how to close them.

A caregiver’s TB test lapses, the shift auto-blocks Friday night, and an MCO later claws back the visits. Here is how agencies get ahead of expired credentials.

A morning caregiver no-shows and one coordinator works a stale list while the family finds out first. Here is how a rapid-fill process covers the shift.

A CHF referral hits your portal at 4:50 Friday and sits until Monday. A faster agency won it Saturday. Here is why nobody owns the referral clock after hours.

You accept the referral, then it dies quietly: unreachable patient, missing F2F, stalled eligibility. Here is why accepted referrals never become admissions.

You cannot staff every referral, so which do you take and how do you keep the rest warm? Here is why first-come-first-served costs you the good-fit cases.

A weekend call-out cascades into missed visits by Monday. Here is how home care agencies cover caregiver call-outs without a missed-visit scramble.

Rotating on-call through daytime coordinators quietly drives the turnover that kills your schedule. Here is who should answer the after-hours phone, and why.

Referrals get accepted first-come first-served, so good-fit cases get declined on busy days and poor-fit cases get taken on quiet ones. Here is the fix.

An outside physician’s note lists your diagnosis in passing, an ADR lands months later, and the MAC denies every episode to start of care. Here is the fix.

When an Axxess OASIS assessment will not lock down, the claim behind it sits. Here is why the OASIS queue stalls billing, and how to keep cash on schedule.

A caregiver in a dead zone cannot clock in and a visit posts with no start time. Here is why incomplete EVV records get visits denied, and how to stop it.

A single week-three cancellation drops your visit count below threshold and flips a $2,000 episode into per-visit pennies. Here is how to catch it in time.

You submitted the NOA on day 4, but it rejected for an MBI typo nobody caught until day 9. Here is why submission is not acceptance, and how to guarantee both.

A Friday admission’s NOE goes in Monday, rejects, and gets accepted day nine. Here is why those provider-liable days are on you, and how to protect them.

You compute the cap once a year, and by filing you are hundreds of thousands over with no reserve set aside. Here is how monthly modeling fixes it.

Your intake line is staffed 9 to 5, but families call after a discharge meeting at 8 PM and on weekends. Here is what that voicemail box costs your agency.

Schedulers fill gaps with whoever answers fastest, one caregiver hits 12 overtime hours, and time-and-a-half against a flat Medicaid rate loses money per visit.

A resident admits Medicaid-pending, the application stalls seven months over one bank transfer, and the facility carries $70,000 unbilled before approval lands.

Your business office keeps paying therapy and lab invoices Medicare Part B should have. Here is why the exclusion list drains SNF revenue, and how to stop it.

A resident returns mid-month and your SNF claim rejects with an overlap edit. Here is why interrupted stays break claims, and who untangles the rebill chain.

A late clock-in or missed punch turns an HHAeXchange visit into an unverified exception you cannot bill. Here is how agencies clear the mismatch queue before the batch.

Your alternate EVV vendor sends visits nightly, but a steady share reject on import into HHAeXchange and sit unbilled. Here is why, and how to close the reconciliation loop.

Your MDS coding sets your Medicaid rate, but if the floor charting does not back it, a state audit unsupports it and recoups. Here is how to close that gap before they look.

A resident moves to a higher care tier in March and billing learns in May. Here is why level-of-care changes stall between clinical and billing, and how to close the gap.

Families budget for the tour rate, then the first statement doubles it. Here is why assisted living move-in fee disputes happen, and how to end them.

Medicaid needs separate auth numbers for PT, ST, and OT, and posting managed care remits in Axxess is line-by-line manual work. Here is how agencies keep splits from denying.

When a PointClickCare census change updates in one place but not another, billing runs on the stale copy. Here is what the drift costs and how to fix it.