Home Health Billing Case Study: 300 Patients, ~2–3% Denials, 100% On-Time NOAs | Right On Time

Case Study · Home Health Billing · San Antonio, TX

Their billing was a black box.
Now: 300 patients, ~2–3% denials — and a report every other Friday.

A Medicare-certified home health agency in San Antonio cycled through a string of billing companies — claims stuck, denials everywhere, and never a single real report on where the money was going. Four years ago they found Right On Time Medical Billing. Today we run everything — eligibility, authorizations, OASIS QA, coding, billing, ADRs, audits — and the owner sums it up in one line: "Whatever comes up, I call Michael."

Medicare-certified home health · ~300 active patients 15+ RNs plus PT & OT team WellSky (Kinnser) 4-year partnership

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300

Active patients per month — billed, followed up, and reported on

~2–3%

Denial rate today — every denial explained, with the action already taken

100%

Of NOAs filed on time — no more Medicare payment reductions for late days

~2 months

To clear the stuck A/R backlog — worked inside timely filing limits

The Situation

300 Patients' Worth of Care. Zero Visibility Into the Money.

This Medicare-certified home health agency in San Antonio, Texas had the operation part figured out: more than fifteen RNs, a full PT and OT team, and a growing census. What they couldn't figure out was their billing — because nobody would show it to them.

They cycled through billing company after billing company, including the billing service attached to their own EMR software. Each one was the same story: claims stuck, denials everywhere, and communication that went nowhere. No real reports. No explanations. The owner never knew what was collected, what was denied, or why — and money was being lost precisely because nobody was watching it.

They weren't losing money because the care was wrong. They were losing it because no one would tell them what was happening.

And underneath the silence, the technical problems were compounding. NOAs were slipping past their deadlines — and every late day is a day Medicare pays less. OASIS assessments weren't being QA'd, and the errors were quietly shrinking Medicare reimbursement episode after episode. Denied claims sat unworked while their timely filing windows ticked down.

Four years ago, they found Right On Time Medical Billing. Here's what happened next.

The Challenge

Every Billing Company Told Them Nothing. It Cost Them Everything.

Before Right On Time, every month looked like this:

Going out, every month

300 patients' worth of care

Skilled nursing, PT, and OT visits delivered on schedule — episodes earned, OASIS completed, claims theoretically in motion.

Coming back, every month

Silence

No reports. No explanations. Stuck claims, mounting denials, late NOAs, shrinking Medicare payments — and an owner finding out only when the deposits fell short.

A revolving door of billing companies

They switched from billing company to billing company — including their EMR's own billing service — chasing one thing: someone who would actually communicate. Every switch meant transition chaos, and every company ended in the same silence.

No reports. No answers. Real losses.

None of them delivered real reporting. The owner never knew what was billed, collected, denied, or written off — and money was lost specifically because nobody was watching. You can't fight a denial you've never been told about.

Late NOAs and unchecked OASIS errors

NOAs slipped past Medicare's window, docking payment for every late day. OASIS assessments went to billing without QA, and the errors quietly shrank reimbursement on episode after episode. Medicare revenue was declining — and nobody had explained why.

Stuck A/R, heavy denials, ADR pressure

Claims sat in A/R with timely filing clocks running down. Denials went unworked and unexplained. And as an agency under heavy medical review, ADRs kept arriving — each one an automatic denial if it wasn't answered completely and on time.

The Turnaround

From Black Box to Biweekly Report — Stage by Stage

Before · In the Dark

Claims stuck. Denials everywhere. Nobody talking.

A string of billing companies had each taken over and gone quiet. No reports, no explanations — just stuck claims, mounting denials, late NOAs, and Medicare payments shrinking from OASIS errors nobody caught. The owner's only signal was the bank deposit.

Money lost without the owner ever knowing why

The Takeover

One team took over all of it

Right On Time took over the entire back office inside their WellSky (Kinnser) system: eligibility verification, prior authorizations, QA of every OASIS and visit note, coding, claim submission, payment posting, A/R follow-up, ADR responses, and audit support. One team, one accountable outcome — and reporting from day one.

The owner's words: "Now they do everything."

The Cleanup

The stuck A/R, cleared in about two months

We worked the inherited backlog claim by claim — corrected, appealed, resubmitted — racing the timely filing limits the previous companies had let tick down. Within roughly two months, the backlog was gone. NOAs moved to a strict on-time process, and OASIS QA started catching the errors that had been shrinking every Medicare payment.

NOAs since: 100% on time

The Payer Strategy

Advice nobody had ever given them

We didn't just bill their payer mix — we fixed it. We advised exiting in-network contracts with major commercial payers that underpaid home health, moved those patients to negotiated arrangements that paid substantially more, dropped Medicaid plans that drained more effort than they returned, and added stronger plans in their place. In the owner's words: "Nobody had ever guided us like that."

Margin decided before a single claim is filed

Today · Year 4

300 patients. ~2–3% denials. And Michael, every other Friday.

Four years in: roughly 300 active patients a month, denials held around 2–3%, every NOA on time, and every ADR answered completely despite heavy medical review. And every other Friday, a full billing report lands — walked through live by Michael Clark, the agency's dedicated account manager. Whatever comes up, the owner makes one call.

"I always know where my money is."

Before · In the Dark

0 reports

from a string of billing companies — while claims stuck and denials piled up

Owner visibility0%

In the Dark

Same Agency, Different Machine

Flip the Switch

Every operational lever of this home health agency, before and after Right On Time took over. Toggle it yourself.

What We Did

Six Moves That Turned a Black Box Into a Biweekly Report

Expand any step — including why it mattered for a Medicare home health agency specifically.

Eligibility verification, prior authorizations, QA of every OASIS assessment and visit note before billing, coding, claim submission, payment posting, A/R follow-up, ADR responses, and audit support — all of it, run inside the WellSky (Kinnser) system the agency already used. After a string of billing companies that each owned a slice of the process and none of the outcome, one team became accountable for the whole revenue cycle.

Why it mattered: fragmentation was the disease. When eligibility, documentation, billing, and follow-up live in different hands, every denial becomes someone else's fault — and nobody fixes the cause.

The inherited backlog was full of claims the previous companies had left sitting — each one with a timely filing clock quietly running out. We worked the entire backlog claim by claim, correcting, appealing, and resubmitting everything still inside its filing window. In roughly two months, the stuck A/R was cleared and collections started landing on rhythm.

Why it mattered: in home health billing, an unworked claim isn't just delayed money — past the timely filing limit, it becomes money that can never be recovered. Speed was the whole game.

Two quiet leaks were draining their Medicare revenue. First, OASIS errors: under PDGM, the OASIS assessment drives the payment, and uncaught errors were shrinking reimbursement episode after episode — the agency watched Medicare revenue decline without knowing why. We put every OASIS and visit note through QA before billing. Second, late NOAs: Medicare docks payment for every day the Notice of Admission is late. We moved NOAs to a strict process — and they've run 100% on time since.

Why it mattered: in Medicare home health, documentation IS the payment. An agency can deliver perfect care and still get underpaid for it — silently, on every single episode.

We told them which plans to accept, which to drop, where to credential and where not to. In-network contracts with major national commercial payers were underpaying for home health — so we advised exiting those contracts and moved those patients to individually negotiated arrangements that paid substantially more. We dropped Medicaid plans that consumed more administrative effort than they returned, and added stronger plans in their place. The owner's reaction: "Nobody had ever guided us like that."

Why it mattered: your payer mix sets your margin before a single visit is billed. Most billing companies bill whatever mix you hand them. Fixing the mix is worth more than perfect billing of a bad one.

This agency sits under heavy medical review, and ADRs arrive constantly. Each one is a deadline: answer completely and on time, or the claim is automatically denied and the payment recouped. Our team owns every ADR end to end — assembling the OASIS, visit notes, orders, and supporting documentation, and submitting inside the window. Every ADR has been answered on time, and the same discipline covers their audits.

Why it mattered: for an agency under review, ADR response isn't paperwork — it's revenue defense. Every missed ADR is a full claim clawed back, and a pattern of misses invites even deeper scrutiny.

The thing every previous billing company refused to give them, we made the centerpiece. Every other Friday, the owner receives a complete billing report — and Michael Clark, their dedicated account manager, walks through it with them: what was collected, any denials and the action already taken on each one, and anything needed from the agency's side, like visit notes pending completion. Whatever comes up between reports, the owner makes one call — to Michael.

Why it mattered: this is the wound the owner actually carried. Four years of billing companies had cost them real money through silence. The report isn't a courtesy — it's the product.

The Results

Four Years Later, the Scoreboard Reads:

~2–3%

Denial rate today — every denial explained, with the action already taken

300

Active patients per month — 15+ RNs plus a full PT & OT team, all billed by one partner

100%

Of NOAs filed on time — zero Medicare payment reductions for late submission

~2 months

To clear the stuck A/R backlog — worked inside timely filing limits

Every 2nd Friday

A full billing report, reviewed live with Michael Clark — their dedicated account manager

4 years

Of partnership — every ADR answered on time under heavy medical review

Everything we run for this agency today

Eligibility Verification Prior Authorizations OASIS & Notes QA Coding Claims Billing A/R Follow-Up ADR Responses Audit Support Payer Strategy Biweekly Reporting Dedicated Account Manager

Hear It From the Owner

The Story, In Their Own Words

The owner of this San Antonio home health agency recorded their experience on video — including why they took time out of their day to do it.

Recorded by the agency owner. Identity withheld at the client's request — the results are theirs.

They didn't just fix the billing — they told us which plans to accept, which to drop, where to credential and where not to. Nobody had ever guided us like that. Now they do everything, and we're at 300 active patients a month. The best part? I have one guy — Michael. Whatever comes up, I call Michael. And every other Friday I get a full billing report, so I always know where my money is.

Owner, Medicare-Certified Home Health AgencySan Antonio, Texas · Name withheld at client's request

Questions Agency Owners Ask

Home Health Billing — Answered

The questions we hear most from home health agency owners considering a billing partner.

A full-service home health billing company like Right On Time Medical Billing handles eligibility verification, prior authorizations, QA of OASIS assessments and visit notes before billing, coding, claim submission, payment posting, A/R follow-up, ADR responses, and audit support. For this San Antonio agency, we run all of it inside their WellSky (Kinnser) system — the owner's words: "Now they do everything."

Under PDGM, Medicare payment is driven by the OASIS assessment. Errors and inconsistencies in OASIS coding quietly lower the payment on every episode — which is exactly what was happening to this agency before we took over. The fix is QA: every OASIS and visit note is reviewed for accuracy and consistency before anything is billed, so reimbursement reflects the care actually delivered.

Medicare requires the Notice of Admission (NOA) to be submitted within 5 calendar days of the start of care. When it's late, Medicare reduces your payment for every day from the start of care until the NOA is accepted — money that is simply gone. This agency's NOAs were slipping before Right On Time took over; today 100% of their NOAs are filed on time.

An ADR must be answered by the deadline — typically 45 days — with complete documentation supporting the claim, or the claim is automatically denied and the payment recouped. This San Antonio agency has been under heavy medical review and receives frequent ADRs; every single one has been answered on time with complete supporting documentation by Right On Time's team.

Not necessarily. Some in-network commercial contracts pay home health agencies poorly, and some Medicaid plans consume more administrative effort than they return. For this agency, Right On Time advised exiting underperforming in-network commercial contracts, moving those patients to negotiated arrangements that paid substantially more per patient, dropping weak Medicaid plans, and adding stronger ones. Which plans you accept determines your margin before a single claim is ever filed.

This agency receives a full billing report every other Friday, and their dedicated account manager — Michael Clark — walks through it with them: collections, any denials and the actions already taken, and anything needed from the agency's side, like visit notes pending completion. One named person, one phone call, a complete picture of the money every two weeks. That's the standard Right On Time model.

Sound familiar?

You've switched billing companies more than once — and each one went quiet after the handoff
You find out about problems from the bank deposit, not from a report
NOAs are slipping, Medicare payments keep shrinking, and ADRs are stacking up on someone's desk

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Your Turn

You Should Always Know Where Your Money Is.

Whether you're fighting stuck claims and silent billing companies or just tired of guessing, we'll show you exactly where your revenue stands — and what it looks like when eligibility, OASIS QA, NOAs, ADRs, and reporting all run on time, every time.

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