Regional Home Health Agency
120+ episodes per month across Medicare and managed care — PDGM denials, authorization delays, and extended A/R were eroding margins until Ascentiant Health stepped in.
PDGM Denials and Authorization Gaps Were Blocking Cash Flow
This regional home health agency was billing more than 120 episodes per month but struggling to convert that volume into predictable revenue. PDGM-related denials, slow prior authorization turnaround, and inconsistent episode billing had pushed days in A/R to 52 — well above industry benchmarks.
PDGM Denial Volume
Clinical grouping mismatches, HIPPS code errors, and OASIS-to-claim misalignment drove an 11% denial rate — with appeals backlog growing faster than the team could resolve it.
Authorization Delays
Managed care plans required visit-level authorizations with varying medical necessity criteria. Expired or missing auths caused preventable claim holds and rework across multiple branches.
Extended Days in A/R
At 52 days in A/R, cash flow was strained. Aged balances over 90 days had accumulated to nearly $180K, with limited visibility into root causes by payer or episode type.
Operational Blind Spots
Spreadsheet-based tracking and fragmented EHR reports made it difficult for leadership to see episode status, denial trends, or authorization gaps in real time.
Expert RCM + Platform Visibility
Ascentiant deployed a dedicated home health RCM team and onboarded the agency to the Revenue Cycle Operations Platform — giving clinical and finance leaders a single source of truth for episode billing and cash performance.
Revenue Cycle Management
- Episode lifecycle management from SOC through discharge billing
- OASIS-to-claim validation before submission
- Proactive prior authorization tracking across all payers
- Structured denial prevention, appeals, and aged A/R recovery
- HIPPS accuracy review and LUPA threshold monitoring
Revenue Cycle Operations Platform
- Episode and period tracking with billing milestone alerts
- Authorization status dashboards by branch and payer
- Denial analytics by reason code and clinical grouping
- A/R aging views with work queue assignment
- Executive reporting on net collections and denial trends
Measurable Outcomes Within 90 Days
Within the first quarter of engagement, the agency saw sustained improvement across denial prevention, cash velocity, and aged balance recovery.
“We finally have visibility into every episode and authorization. Denials dropped fast, and the platform let our team see exactly where cash was stuck — not just hear about it in a monthly report.”Director of OperationsRegional Home Health Agency · Southeast U.S.
Ready to Strengthen Your Home Health Revenue Cycle?
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