What a margin teardown actually finds in a home-care agency.

The phrase “margin teardown” can sound like marketing. It is not. A teardown is a specific, narrow thing. It is a read-only pass over an agency's own billing data that reconciles four facts: what was authorized, what was delivered, what was billed, and what was paid. It then lists every place they fail to agree, with the dollars and the reason attached. No projections. No industry averages applied to your book. No “agencies like you typically see…” The teardown only reports what is actually sitting in your own data.

This guide walks through what a teardown actually surfaces, so the value is concrete before anyone talks about working together.

Why it leads with proof

Home care is a vertical full of vendors making promises. An operator has heard every version of “we'll improve your revenue.” A teardown inverts that. Instead of asking you to believe a claim, it shows you the recoverable dollars in your own book first. You keep those findings whether or not you ever buy anything. That only works if the read is honest, which is why a teardown reports findings line by line, with the source of each one, rather than a single impressive-sounding number.

The categories a teardown surfaces

Across home-care books, recoverable revenue tends to cluster in the same handful of categories. A teardown is built to find each of them:

• Unbilled authorized hours. Care that was authorized and delivered but never made it onto a claim. This is the cleanest category. The work was approved and done, and the billing simply never happened.
• Unit and code mismatches. Claims where the units billed do not equal the units delivered or authorized, or where the service code does not match the authorization. These deny or underpay, and they often repeat across every claim carrying the same error.
• Silent underpayments. Lines that paid below the contracted or authorized rate. Because they paid something, they never appear in the denial queue. They only show up when payment received is compared to payment expected.
• Denied and never reworked. Claims that denied for a fixable reason, such as an EVV mismatch, an authorization issue, or a coding error, and were never corrected and resubmitted before they aged toward the filing deadline.
• Authorization drift and lapses. Claims that fell outside the current authorization because it changed or expired and the billing did not follow, turning delivered care into unbillable care.
• Overtime and scheduling leakage. Patterns where the way visits were staffed and covered drove avoidable cost. This is the expense side of the same margin question.

Each finding carries a reason and a recoverability flag: whether it can still be corrected and rebilled inside the filing window, or whether it is a process fix that stops the leak going forward.

What the read actually is

A teardown is read-only. It observes the data and reports. It does not write back to the billing system, change claims, or touch the EMR's workflow. It works over a de-identified slice of the agency's data, with client names tokenized before any analysis runs, or screen-to-screen, so identifiable data never has to leave the building. And it is EMR-neutral. It reads whatever the agency already runs, WellSky, AxisCare, HHAeXchange, AlayaCare, or anything else, with no stake in which system that is and no reason to look past a finding that implicates a billing module.

A teardown is not a projection, a benchmark applied to your book, or a number invented to impress. Industry figures on claim denials and rework do exist. Healthcare claim rework is often estimated in the range of tens of dollars per claim, and a large share of denials are considered avoidable. But those are context, not your result. A teardown's job is to replace the industry average with your actual number.

What you do with the findings

The output is a ranked list of recoverable dollars, each with its reason and its filing-window status. Start by reworking the recoverable denials and unbilled hours still inside the window. That is money you can collect now. After that, fix the process leaks the teardown exposes, so the same category does not refill next quarter. The findings are yours to act on with or without further help. The engine that produced them, described across the rest of this site, is simply the way to keep doing it continuously instead of once.

For the full map of where these losses originate, see where home-care margin leaks. For the silent-loss side specifically, see the authorization-to-claim gap. To watch the read happen on sample data, see the live teardown.

The takeaway for operators

A margin teardown is worth doing because it answers a question most agencies cannot answer precisely: how much money did we earn and never collect, and how much can we still get back? It replaces a vague worry with a ranked, sourced list of your own recoverable dollars. It is free, it is read-only, and the findings are yours either way. In a vertical where every vendor leads with a promise, the teardown leads with your own books. That is the only proof that actually counts.