Your revenue cycle report arrives with claim totals, aging balances, and collections. But you still have questions. Why is that balance growing? What is holding up payment? Is anyone working on it? What needs your attention?
A home health RCM partner should tell you why claims are unpaid, what is being done to resolve them, which recurring issues need agency action, and how performance is changing over time. Good reporting connects each number to an explanation and a next step.
Whether you outsource billing alone or use full home health revenue cycle management, these five questions will help you judge the information you receive.
1. Why Are Our Home Health Claims Unpaid or Delayed?
Your RCM partner should explain the reasons behind unpaid balances, separate real problems from claims still moving through the normal payment cycle, and show where follow-up is needed.
An accounts receivable total tells you how much is outstanding. It does not tell you whether those balances are awaiting payer processing, missing documentation, held up by authorizations, or stalled by billing errors.
“AR over 60 days increased” identifies a change. A useful report shows which payers or claims drove the increase, what is preventing payment, and what action is underway.
Ask your partner:
- Which balances are still within the expected payment cycle?
- Which claims need correction or more information?
- Are delays concentrated with one payer?
- Are older balances moving toward resolution?
- Which issues need agency action?
Also separate unbilled work from submitted claims awaiting payment. Both affect cash flow, but they need different responses.
What a useful answer sounds like: “The increase is concentrated with one payer. Several claims are awaiting requested records, and others need payer follow-up. Here is the balance tied to each issue and the next action for each group.”
2. What Is Our RCM Partner Doing to Resolve Denials and Aging AR?
Your partner should give a clear account of the work completed, the current status, and the next action for denials and aging accounts receivable within its scope. “Under review” or “being worked” leaves too much unanswered.
For significant unresolved balances, you should know:
- Why the claim was denied or remains unpaid
- What correction, follow-up, or appeal has been completed
- Whether the payer has responded
- What information is still needed
- Who owns the next action
- When follow-up or escalation will happen
Your partner should also separate older AR inherited at onboarding from claims managed during the current engagement. That makes it fairer to evaluate both recovery work and current billing performance.
Look Beyond the Number of Claims Worked
Activity counts show that follow-up is happening. They do not show whether balances are moving toward payment. Ask what changed: Was a claim corrected? Did the payer confirm receipt of records? Was a denial overturned? Is an appeal awaiting a decision?
Some claims stay unresolved despite good follow-up. Leadership still needs a clear explanation of the remaining barrier and the options.
What a useful answer sounds like: “We submitted the requested records and confirmed receipt. The payer has not issued a determination. The next follow-up is scheduled, and we will escalate if the claim is unresolved by the agreed review point.”
3. Which Billing, Documentation, or Authorization Issues Need Our Attention?
Your RCM partner should identify recurring payment barriers, explain their financial impact, and make specific requests when your agency needs to act.
You don’t need every claim issue escalated to you. You do need to know when a pattern calls for a decision, staff education, or a process change. Examples:
- Repeated documentation questions that keep records from being ready to bill
- Authorization information that is often missing when needed
- Recurring claim errors tied to a specific payer requirement
- Outstanding orders affecting a growing group of claims
The explanation should separate a confirmed cause from a suspected one. A trend can point to an area worth investigating without proving why it is happening.
Ask for the Impact and the Requested Action
“Documentation is delaying billing” is too broad to act on. A stronger update names the missing information, the affected records, how long they have waited, and what the agency needs to do.
What a useful answer sounds like: “Several records are awaiting the same clinical clarification. We’ve identified the affected charts and sent specific questions. We need an agency contact to coordinate responses, and we recommend considering focused education on this issue.”
4. Which Home Health Revenue Cycle Metrics Show Whether Performance Is Improving?
Your RCM partner should use consistently defined measures to explain trends over time: where performance is improving and where problems remain.
A single number rarely tells the full story. Collections may rise simply because the agency grew. An AR balance may shift because of payer mix, billing volume, or older balances entering the report.
| Measure | What it helps you evaluate | What your partner should explain |
|---|---|---|
| Unbilled balances and billing lag | Whether completed work is moving toward claim submission | What is preventing billing and how long items have been waiting |
| AR aging | How outstanding balances are distributed by age | Which payers and issues account for older balances |
| Denials and rejections | Where claims hit payment barriers | How each category is defined, the leading reasons, and resolution trends |
| Collections | How much payment is coming in | How results relate to billing activity, timing, and agency changes |
| Payer payment trends | Whether payment patterns differ across payers | Where delays or discrepancies need investigation |
Agree on definitions before comparing results. A denial rate based on claim counts answers a different question than one based on dollars. Ask whether reports use the same date ranges, balance categories, and calculation methods each time, and whether any change in method is called out.
For a closer look at payment timing, see our guide to days sales outstanding or try the DSO calculator.
Connect Metrics to Decisions
The useful conversation goes beyond whether a metric went up or down. If unbilled balances dropped, what changed? If older AR rose, where is it concentrated? If denials fell, is that fewer problems, lower volume, or a reporting difference? Your partner should explain what the evidence supports and where more review is needed.
5. What Should Our Agency Prioritize to Improve Collections and Cash Flow?
Your RCM partner should turn reporting into a short list of priorities based on financial impact, urgency, and what your agency can act on.
A long list of open issues makes everything feel equally urgent. Priorities might include resolving a group of blocked claims, meeting approaching deadlines such as payer records requests, investigating a payer payment pattern, or fixing a recurring source of billing delays.
Each priority should identify:
- The problem and the affected balance or claim group
- Why action is needed
- The next step and accountable owner
- When it will be reviewed
- How progress will be measured
Not every problem needs a major operational change. Sometimes a focused correction is enough; other patterns call for a broader review.
What a useful answer sounds like: “Our immediate priority is the claims awaiting records, because those requests have approaching deadlines. Next, we recommend reviewing the recurring authorization issue on new claims. We’ll report progress on both at our next review.”
How HealthRev Partners Connects Reporting With Follow-Through
HealthRev Partners’ home health billing services can include claims submission, denial management, payment posting, and accounts receivable recovery, with additional support based on your agency’s needs.
As part of those services, our Velocity platform gives agencies visibility into chart status, denial trends, and outstanding AR. Its Communication Center connects agency clinical teams with HealthRev’s billing, coding, and review staff, keeping chart-related questions in one place.
That connects a financial concern to the records, questions, and follow-up behind it, so conversations focus on what is holding up reimbursement, what is underway, and where your team is needed.
Frequently Asked Questions
What should a home health RCM partner report each month?
At minimum: unbilled balances and billing lag, AR aging by payer, denials and rejections with leading reasons, collections, and payer payment trends, each with an explanation of what changed and the next action.
How should our RCM partner separate denials from rejections in reports?
Report them as separate categories with clear definitions, the leading reasons in each, and how quickly each is being corrected or resolved. They have different causes and different fixes, so combining them hides what needs attention.
How do we know if our RCM partner’s follow-up is working?
Look for outcomes, not activity counts: claims corrected, records confirmed received, denials overturned, and older balances moving toward payment, each with a named owner and next step.
How should denial rates be measured?
Agree on one definition and use it consistently. A rate based on claim counts shows how often claims are denied; a rate based on dollars shows how much revenue is affected. Compare like with like.
Expect Answers You Can Use
Your home health RCM partner should help you understand the story behind your revenue cycle: why balances are unpaid, how open claims are progressing, which patterns need attention, and what to do next. Those answers make reporting useful, and they give you a clear basis for evaluating the partnership.
If your reports leave you with more questions than direction, speak to a specialist about getting clearer visibility and follow-through for your agency.
