RCM Case Study: Stabilizing Cash Flow and Compliance for a Home Health and Hospice Provider Through Specialized Revenue Cycle Management

A growing home health and hospice agency in the USA partnered with Dilijent Systems to regain control over its revenue cycle and enhance reimbursement accuracy.

The agency served both home health and hospice patients with a large number of patients all over the USA. The agency served a large volume of patients, a high volume of OASIS assessments, hospice certifications, and recurring claims. Despite all this, the agency faced revenue losses because of complaint issues and billing denials.

The Challenge:

Before working with us, the agency faced several ongoing challenges:

High Claim Denials and Rejections

Denial rate averaged 20-24%. These claim denials were mainly due to OASIS billing errors. Missing physician signatures and complaint issues. 

Delayed Medicare Payments

AR days regularly exceeded 65 days, creating cash flow pressures and operational strains. 

Documentation and Compliance Gaps

Inconsistent clinical documents lead to denial and audit risks.

Billing Complexity Across Services

Managing both home health and hospice created a lot of billing errors.

Staff Burnout and Rework

Clinical and billing teams spent excessive time correcting claims and resubmitting documents. This lead to staff burnout, and they couldn’t focus effectively on their tasks.

How Dilijent Systems Solved the Problem

Dilijent Systems deployed a special home health and hospice setup that enables the agency to continue its billing tasks with much efficiency. Here are some of the main solutions Dilijent Systems brought:

Complete RCM Assessment Process

We commenced our analysis through an extensive examination, which covered six months of home health and hospice claims data to determine the exact causes of revenue losses. The process involved conducting a thorough examination of all OASIS submissions, together with physician certifications and billing procedures. We discovered compliance deficiencies, operational failures, and unidentified revenue loss areas through our analysis of the revenue cycle process.

OASIS and Documentation Optimization

We established OASIS accuracy reviews, which operate before claims submission to achieve better compliance outcomes and decrease denial rates. The clinical documentation system received development to match current Medicare standards, thus maintaining consistency and audit readiness. We developed standard documentation checklists that enable clinicians to submit correct documentation without extra work.

Clean Claim and Billing Workflow

We restructured the billing process to create an efficient system that enables clean claim processing from the beginning. The system enhancements for episode management and visit utilization tracking brought main improvements, which eliminated both timing issues and billing mistakes. The company assigned highly experienced billers from home health and hospice operations to manage the account and ensure that all claims reached their submission deadlines while following payer regulations.

Denial Management and Appeals

The organization created a team that specializes in Medicare denial resolution to handle all rejected and denied claims with efficiency. The organization established a fast appeal system that relies on precise and comprehensive documentation. The organization used denial trend data to identify and fix root problems, which stopped future issues from happening again.

A/R Follow-Up and Cash Acceleration

We found cash flow enhancement opportunities through our focus on Medicare claims and high-value claims, which needed follow-up. The organization established an A/R system that handles all claims that have remained unpaid for more than 30 days, thus decreasing the number of uncollected accounts.

Results Achieved (Within 120 Days)

1. Denial Rate Reduced from 24% to 7%

Driven by stronger documentation and OASIS accuracy.

2. A/R Days Reduced from 65+ to 30 Days

Significantly improved and predictable cash flow.

3. Medicare Reimbursement Increased by 31%

Recovered lost revenue and reduced downcoding.

4. Clean Claim Rate Increased to 95%

Faster payments and fewer rework cycles.

5. Audit Risk Significantly Reduced

Improved compliance and documentation consistency.

6. Staff Efficiency Improved by 22%

Less rework allowed teams to focus on patient care and growth.

Client Testimonial

Dilijent Systems brought efficiency and confidence back into our revenue cycle. Our payments are faster, denials are under control, and our team is no longer stressed by billing issues. We finally feel compliant, stable, and supported.
Director of Operations, Home Health and Hospice Agency