Eight home care billing errors that show up on every agency's books.
Most billing errors are not random. The same eight recur across every size of agency and every EMR, and each has a tell and a fix.
The eight
Delivered hours that never became a claim. Care was documented and no claim was ever built. Fix by reconciling scheduled and confirmed visits against submitted claims each closed period.
Authorization date or unit mismatches. The visit falls outside the auth or exceeds remaining units. Fix with a pre-billing auth check that blocks the claim from going out.
The wrong modifier for the service type or time of day. Fix by mapping every scheduling service type to the correct modifier and rate for each payer, and refreshing that map on any contract update.
EVV data not transmitted before the claim was built. Fix by comparing scheduled visits against the aggregator received-records report before the batch runs.
A rate from an outdated contract. Fix by verifying rates after any update and checking the first remittance after the new rate takes effect.
Duplicate claims across cycles. Fix by confirming the original was voided before resubmitting and turning on duplicate detection in the EMR.
Thin or non-specific visit documentation. Fix with a documentation standard of specific tasks, refusals, and condition observations, and a weekly spot-check.
Timely filing missed through scheduling-to-billing gaps. Fix with a weekly comparison of scheduling to claims that flags any visit over 30 days without submission.
Where they surface
All eight show up on remittances, on the AR aging, or in an audit. Never at the moment they happen. That is why pre-billing checks beat back-end cleanup: by the time a denial or a recoupment appears, the visit is already weeks old and closer to the filing wall.
Plain answers, on the record.
Collect is money you never captured. Cover is money a payer can still take back.
Reeve reports the two separately and never adds them together, because only one of them is yours to go and get. The Margin Review reads both on your own export and costs nothing.
One pass over your own export, in your browser. The findings are yours to keep, with no obligation.
The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.
Everything in Collect, plus the exposure lane. Retired codes, authorizations at the end of their period, care delivered past what was approved.
Month to month, no annual contract. Read-only in every tier. Run the free review.
Find the eight on your own books.
The Margin Review runs the same checks on one closed period and returns a ranked list of recoverable dollars with a reason on each line.