Accounts Receivable Days Reduction Case Study
82 → 34 days
A/R Days
$2.4M
Cash Flow Unlocked
97%
Clean Claim Rate
$380K
Underpayments Recovered
How we reduced a home health agency's A/R days from 82 to 34, unlocking $2.4M in cash flow and recovering $380K in systematic payer underpayments.
The Challenge
A home health agency with $12 million in annual revenue was operating with 82 A/R days—nearly double the industry high-performance benchmark of 40–45 days. The cash flow gap was forcing the agency to use a line of credit to cover operating expenses between the time services were rendered and payment was received. At peak usage, the line was drawn to $1.8 million, generating $72,000 annually in interest expense on revenue the agency had already earned. The billing department was running continuously but not effectively. Claims were being submitted promptly, but a 74% clean claim rate meant that one in four claims was rejected or denied at initial submission. The rework queue had grown to over 450 active cases, with the oldest items exceeding 120 days—approaching the timely filing limits for several payers. Leadership knew the revenue cycle was underperforming but lacked the data visibility to understand where. Monthly A/R reports showed the total figure but not its composition—which payers were slowest to pay, which denial reasons were most common, and how much of the outstanding balance was likely uncollectible.
Our Solution
A/R Aging Deep Dive and Payer Segmentation We conducted a full A/R aging analysis segmented by payer, denial reason, service type, and submission date. This revealed that three payers accounted for 61% of the 90+ day A/R bucket, and the top five denial reasons across all payers accounted for 79% of total rejected claims. The data immediately focused remediation efforts on the highest-impact areas rather than spreading attention uniformly across the entire A/R portfolio. Clean Claim Rate Improvement Working from the denial root cause data, we implemented corrective workflows for each of the top five denial reasons: eligibility verification at 24 hours pre-service (eliminating coverage mismatch rejections), authorization confirmation before each service date, documentation completeness checks at the point of care, coding accuracy review using AI-assisted tools, and payer-specific claim edits for the three high-denial payers. Clean claim rate improved from 74% to 97% within 90 days. Automated Follow-Up and Backlog Clearance We deployed automated claim status tracking across all active payers, generating daily follow-up tasks for claims exceeding expected adjudication timelines. The 450-item backlog was cleared over 75 days through a dedicated work-down effort, with claims prioritized by dollar value, payer deadline, and likelihood of recovery. $1.1M in previously stuck A/R was collected during this period. Underpayment Identification and Recovery A secondary analysis compared paid claims against contracted rates for all active payers. This identified $380K in annual underpayments—claims where payers had adjudicated below contracted amounts without generating an explicit denial. We built automated underpayment detection into the payment posting workflow and submitted contractual dispute letters for all identified underpayments, recovering $380K over six months.