3 Hidden Ways Home Care Agencies Leak Revenue (And How to Fix Them Fast)

In Medicaid-based home care, margins are thin and the work is demanding. You can’t always control payor rates or policy changes—but you can control how much of your earned revenue quietly slips away.

Most agencies focus on obvious issues like poor payer mix. However, the biggest losses usually come from three "invisible" leaks hiding inside your everyday workflows. Let’s break them down—and more importantly, how to plug them.

1. “Invisible” Care: Visits That Never Make It to Billing

The Leak

Care was delivered, but it never hit the claim. This represents work you already paid for in payroll but never recouped from Medicaid. Common symptoms include:

• EVV records that don’t match scheduled times.

• Visits stuck in “pending review” or missing signatures.

• Staff finishing notes days (or weeks) later.

Why It Happens

Caregivers are focused on people, not paperwork. If your system doesn’t make it painfully obvious when a visit is “not billable yet,” it’s easy for these visits to stall out or disappear into the archives.

The Fast Fix

• Create a "Clean-Up" Dashboard: Highlight visits missing signatures or EVV data. Assign one person to clear this list every 24 hours.

• The 24-Hour Rule: Enforce a strict deadline for documentation. If it isn't signed in 24 hours, it’s an immediate red flag.

• Simplify the Workflow: Reduce the "taps and swipes." Use templates so caregivers don't feel like they're writing a novel.

2. Authorization Mismatches: Tiny Errors, Big Denials

The Leak

The visit happened, but the claim is denied for a "technicality." This is often due to:

• Using the wrong modifier or service code.

• Exceeding weekly/monthly units.

• Visits occurring outside the authorized date range.

Why It Happens

Authorizations often live in PDFs or emails, while schedules live in a separate system. When these two don't talk to each other, the leak starts at intake and ends as a denial weeks later.

The Fast Fix

• Sync Authorizations to the Schedule: Treat the authorization as the "source of truth." If the auth says 20 hours, the schedule should physically prevent 21.

• Build Smart Guardrails: Set up automated alerts that flag a scheduler before they book a visit that exceeds a limit.

• The Denial "First Aid Kit": Identify your top 3 denial codes and create a 1-page cheat sheet for the billing team to fix and resubmit them within 48 hours.

3. Slow Follow-Up: Letting Denials Collect Dust

The Leak

Many agencies track what they bill, but few track what they actually collect. The gap is made of denied claims never resubmitted and small underpayments that are "too small to chase."

Why It Happens

Billing teams are often too busy getting the next batch of claims out to look backward. Without clear ownership of A/R (Accounts Receivable), Medicaid’s strict correction timelines often expire, forcing a write-off.

The Fast Fix

• Standardize the Remittance Review: Make reviewing ERA/EOBs a weekly requirement, not an "if we have time" task.

• Assign a "Denial Owner": Don't let follow-up be everyone's responsibility (which usually means it's no one's). Assign one person to categorize and fix denials weekly.

• Watch Your A/R Days: If your average "Days in A/R" is creeping up, you have a follow-up problem.

Your 30-Day Plug-the-Leak Roadmap

Final Thought

You don’t control Medicaid policy, but you do control your own efficiency. By plugging these three leaks, you transform revenue leakage into predictable cash flow that supports your caregivers and your clients.