CASE STUDY: New York Home Health Agency

In 2009, Claims Resolutions got its very first client: a home health agency in New York. This isn’t the story of a big business. This is the story of a small business owner, someone just like you or me. This particular business owner happened to be the mother of a disabled child. She’d had trouble finding high-quality home care in the past and started her company so families like hers could find services for their children.

By the time she found us this agency was just a few months away from closing its doors. The owner was a wreck—stressed out, in debt, trying to figure out how to make payroll, all while continuing to care for her special needs child. She’d made heroic efforts, but New York State Medicaid refused to pay her bills for over a year.

Our team went through her entire process with a fine tooth comb. We audited all of her past rejected and denied claims on the back end, even as we improved intake procedures on the front end.

There was plenty of room for improvement. Our client’s specialty was bridging the gap between patients and providers. She was focused on care, not labyrinthine insurance company requirements. As it should be—hospitals, clinics, agencies and other providers should be focused on the wellbeing of their patients. That should be the primary concern, even in the modern environment, which is focused on doing more with less.

Eventually we were able to start sending some test claims. It was awesome to see the look of pure relief on her face when these test claims started generating some revenue at last.
Of course, the day she recouped a half million dollars in unpaid receivables we all broke out the champagne. It felt great to know we’d played a role in keeping this agency on its feet.

Today, this home health care agency continues to serve families with special needs children throughout the state of New York. And we know our client is unlikely to ever face such a dire scenario ever again. She continues to use the new processes we put into place. We also reached out to our network to find her some staff members who can keep an eye on day-to-day billing. And, of course, we’re still here to help whenever a big, hairy billing problem comes across her desk.

Every day, our clients focus on helping patients while we focus on managing the administrative and billing burden imposed by insurance companies, current legislation, and the overall health care system. Are insurance companies refusing to pay your practice? Call the specialists at Claims Resolutions today to find out how we can get your practice back in the clear.