Denied claims are more than a paperwork hassle – they’re a direct hit on an agency’s financial health.
In our recent presentation, Proactively Fighting Home Health Claim Denials: A Practical Approach for Agency Owner and RCM Specialists, we teamed up with HealthRev Partners to explore why so many denials happen – and how to stop them before they cost your agency time and revenue.
Here’s a quick recap of the most important insight and steps you can take today.
The Hidden Cost of Claim Denials
Many agencies underestimate how much denials drain their bottom line:
- 20% of claims are initially denied or delayed
- It cost an average of $25-$117 to rework a single denied claim
- Up to 65% of denied claims are never resubmitted, representing significant lost revenue.
These numbers highlight why tackling denials can pay off quickly – especially when you address the root cause.
Top Preventable Causes of Denials
The discussion revealed that many denials are avoidable when agencies focus on the right areas:
- Documentation gaps: Notes that don’t fully support medical necessity or plan of care.
- Eligibility and authorization issues: Missed or late verifications that lead to automatic rejections.
- Timeliness and process delays: Bottlenecks in chart review or late record submission.
- Coding or OASIS inconsistencies: Inaccurate or incomplete data causing payer pushback.
A common theme: More complete documentation upstream prevents revenue loss downstream.
Real-World Wins: Strategies that Work
Amedisys Hospice Case Study
- Using speech recognition improved the quality of CTI narratives.
- Narratives grew 42% longer with stronger inclusion of medical details.
- Documentation error rates dropped from 15% to 3% in 9 months.
- Physicians cut documentation time by 50% while improving compliance and work-life balance.
A Denial Recovery Example
One agency leader shared how a systematic denial review helped recover $287,000 in previously lost revenue – a powerful reminder that addressing denials pays off.
Action Steps for In-Home Health Agencies
To prevent denials and speed reimbursement, agencies should focus on:
- Strengthening documentation at the point of care so notes support medical necessity from day one.
- Improving visibility across the revenue cycle with alerts and tracking to flag issues early.
- Eliminating recurring issues by analyzing denial trends and correcting root causes.
- Engaging clinicians in the process with tools that make documentation faster and more accurate.
What Agencies Should Remember
Denial prevention isn’t just a billing department task. It’s a team effort that starts with accurate, timely documentation and continues with strong revenue cycle management.
By focusing on these areas, agencies can cut rework, improve cash flow, and deliver greater clinician satisfaction.
Watch the Webinar On-Demand
Missed the live session? Watch the full webinar replay to see how documentation and revenue cycle strategies work together to reduce denials, protect revenue, and improve compliance.
If you’re interested in learning more about how nVoq’s innovative AI-powered solutions can lighten the documentation load for your clinicians, our experts are ready to help.
Speak to an Expert