Home Health & Hospice
Episode-based billing means denials with more moving parts than anyone else's.
Home health and hospice denials aren't single-claim events — they're episode unwinds. One missing face-to-face note or late recert can claw back an entire period of care your team already delivered.
You, Specifically
You operate under documentation rules no office practice would recognize: face-to-face encounter requirements, OASIS timelines, recertification windows, ADR response deadlines. Each one is a tripwire, and each tripwire can take down a whole episode's payment — not one visit's.
Your margins were thin before the referral even arrived. When an ADR lands or a MA plan denies the episode, the choice is brutal: pull a clinician-hours-worth of chart assembly, or eat five figures. Most agencies eat it.
The Patterns
The denials we see in your world, over and over.
- Face-to-face documentation denials unwinding full episodes
- ADRs (Additional Documentation Requests) that lapse into denials on deadline
- Eligibility and episode-overlap denials across Medicare and MA plans
- Recertification-timing denials
- MA plans applying prior-auth and review layers traditional Medicare never had
The Engagement
What working with us looks like.
01
ADR response management: chart assembly and submission inside the deadline, every time.
02
Episode-level appeals — face-to-face, eligibility, and recert denials argued with the full record.
03
Deadline dashboard across every open ADR, appeal, and filing window.
04
Root-cause reporting that ties denials back to intake, documentation, or recert workflow.
Pricing
Episode-value claims make contingency pricing especially efficient for agencies — and the flat-rate program is available in all 50 states. Both start with the free Recovery Audit ($500 value).
See both pricing models →Know your number before you sign anything.
The Recovery Audit is a $500 analysis — yours free, in writing, with an honest go/no-go. Limited slots each month.
Sources
- 1.Medicare Advantage denials jumped 4.8% from 2023 to 2024; commercial plan denials rose 1.5%. — Industry claims data, 2024
- 2.Of denied Medicare Advantage claims that ARE appealed, roughly 54–57% get overturned. — Federal MA appeals data / KFF