A mid size Ohio hospice was sitting on a growing pile of rejected and suspended claims, not because the charting was wrong, but because nobody owned the portal. Here's how the revenue came unstuck. The agency's name is withheld to protect confidentiality, the numbers are representative of engagements like this one.
The clinical side was doing its job. But at a mid size Ohio hospice running an ADC of about 120, a growing pile of rejected and suspended claims was quietly building up inside the NGS portal. Nobody owned the follow up, so nothing moved, the claims just sat there, aging.
The knock on effects were worse than the backlog itself. NOEs were slipping past the 5 day filing window, and eligibility overlaps were turning into non covered days that never got caught in time. Money the agency had already earned was leaking out through a workflow gap no one had been assigned to close.
We moved the agency onto the Revenue & Audit Shield tier and gave the portal a single, accountable owner. Instead of the backlog being everyone's problem and no one's job, it became a daily discipline.
Within a quarter, the backlog was gone and the revenue cycle was running clean.
$180K in previously stuck revenue was cleared inside the first quarter, days in AR fell by roughly a week as claims stopped aging in the portal, and with NOE tracking in place the agency hasn't missed a single filing window since go live. The clinical team never had to change how they charted, the leak was in the workflow, and that's where we fixed it.
“It paid for itself in a few months. We're seeing far fewer rejected claims, and the whole team finally has room to breathe.”Agency Administrator, mid size hospice, OH
Start with a workflow audit, we'll map your leakage points and show you the recoverable hours and revenue before you commit to anything.