Most Medicaid home care agencies earn less than they should — not because they're billing incorrectly, but because of three structural gaps that sit between authorized care and collected revenue. The diagnostic quantifies each one for your agency specifically.
~$2,400
Authorization Drain
Authorized hours that expire unused, reauthorization gaps that create unbillable periods, and utilization rates that go untracked until an authorization runs out mid-service. This is the largest drain vector for most agencies at 30 patients.
~$1,100
Claims Drain
Denied claims that go unworked past the appeal window. Submission errors caught after filing. Timely filing deadlines missed because denial management isn't resourced. Revenue that was earned but never collected.
~$600
Compliance Drain
Lapsed caregiver credentials that block billing retroactively. Documentation gaps that trigger audit exposure. Visits delivered but unbillable because EVV verification wasn't confirmed before the submission window closed.
These figures represent approximate monthly averages at 30 active patients, derived from CareBravo agency data. Your actual number scales with patient volume, payer mix, and the specific gaps your diagnostic identifies. Agencies at 90 patients typically see combined drain approaching ~$12,300 per month across all three vectors.