Recovering $4.1M in stalled claims for a private-duty agency

A 600-client private-duty home care agency in Atlanta had $4.1 million sitting in open accounts receivable, much of it aged beyond 90 days. The internal billing team was consumed by daily claim submission and had no bandwidth to work denials, so unpaid claims aged quietly until month-end, when the CFO would discover a cash shortfall. The payer mix compounded the complexity: managed Medicaid claims flowed through HHAeXchange with its own evoucher and prior-authorization rules, several private-pay contracts required manual invoicing, and two long-term care insurance carriers demanded documentation packets that the agency was submitting inconsistently. One recurring denial pattern—a missing service note timestamp—was quietly rejecting roughly 8% of claims at one payer, but nobody had the time to investigate why. The CFO needed weekly cash visibility and got month-end surprises instead. The owner had considered hiring a senior billing manager, but the real need was specialized AR-recovery muscle, not another generalist.

Rising Star Solutions layered a dedicated AR-recovery specialist and an HHAeXchange billing lead onto the existing in-house team. The AR specialist triaged every open claim by payer and aging bucket—0–30, 31–60, 61–90, and 90+—and worked the oldest, highest-value claims first. Within 60 days, the $4.1M in stalled AR had been systematically addressed. Before any new claim was submitted, we rebuilt the claim-cleanliness checklist—verifying service note timestamps, caregiver signatures, evoucher authorization, and payer-specific documentation—so the root causes of denials were eliminated upstream, not just patched downstream. The first-pass clean-claim rate climbed from 76% to 94% within four months. We also delivered a weekly aging report to the CFO: total AR, AR by aging bucket, AR by payer, cash collected this week, and projected next-week collections. Using the clean data we'd gathered, we renegotiated response SLAs with two payers and eliminated the missing-timestamp denial pattern entirely by adding an automated timestamp check to the submission workflow.

$4.1M in stalled AR recovered and days-in-AR cut by a third