Notes on the Medicaid back office.
Reference briefs for home care agency owners — EVV, billing, and the places revenue quietly leaks. Written to be useful whether or not we ever work together.
The Money That Never Comes: Why Medicaid Providers Wait Months to Get Paid for Work Already Done
For thousands of home care agencies, behavioral health providers, and community-based organizations across the country, delivering Medicaid-funded services is only half the job. The other half is getting paid for it — and that half can take weeks, months, or in some cases, never happen at all.
On paper, Medicaid is straightforward: a provider delivers an authorized service, submits a claim, and receives reimbursement. In practice, the system is anything but. Agencies routinely report six-figure sums sitting in accounts receivable, tied up not because the work wasn't done, but because of how the claims pipeline is built.
Read the brief →Going Under by the Books: How Unpaid Claims Are Pushing Medicaid Providers Out of Business
Home care and PASA agencies operate on notoriously thin margins to begin with — often in the single digits. Layer on a billing cycle where a meaningful share of legitimately worked hours are delayed, denied, or stuck in appeal, and an agency can be fully booked and still run out of operating cash. Payroll doesn't wait for a claims dispute to resolve; reimbursement does.
Compliance or Collapse: The Regulatory Maze Medicaid Agencies Can't Afford to Get Wrong
EVV compliance alone illustrates the complexity: the federal mandate sets the baseline, but each state chooses its own vendor model, data format, and exception-handling process. A workflow built for one state's EVV system often doesn't transfer cleanly to another.
The Staffing Crisis No One's Fixing: Why Medicaid Providers Can't Find (or Keep) Good Workers
Medicaid reimbursement rates are set by the state, which means the ceiling on what an agency can pay its caregivers is effectively set by the state too — regardless of local labor market conditions. When retail, hospitality, and warehouse jobs offer comparable or better pay with less physically and emotionally demanding work, agencies are competing for talent with one hand tied behind their back.
Denied, Delayed, Appealed: Inside the Broken Claims Cycle Draining Medicaid Agencies
This isn't a rare glitch. Denial rates for Medicaid home and community-based services claims routinely run into the double digits, and a meaningful share of those denials have nothing to do with whether the care was delivered.
All briefs
Going Under by the Books: How Unpaid Claims Are Pushing Medicaid Providers Out of Business
Home care and PASA agencies operate on notoriously thin margins to begin with — often in the single digits. Layer on a billing cycle where a meaningful share of legitimately worked hours are delayed, denied, or stuck in appeal, and an agency can be fully booked and still run out of operating cash. Payroll doesn't wait for a claims dispute to resolve; reimbursement does.
Compliance or Collapse: The Regulatory Maze Medicaid Agencies Can't Afford to Get Wrong
EVV compliance alone illustrates the complexity: the federal mandate sets the baseline, but each state chooses its own vendor model, data format, and exception-handling process. A workflow built for one state's EVV system often doesn't transfer cleanly to another.
The Staffing Crisis No One's Fixing: Why Medicaid Providers Can't Find (or Keep) Good Workers
Medicaid reimbursement rates are set by the state, which means the ceiling on what an agency can pay its caregivers is effectively set by the state too — regardless of local labor market conditions. When retail, hospitality, and warehouse jobs offer comparable or better pay with less physically and emotionally demanding work, agencies are competing for talent with one hand tied behind their back.
Denied, Delayed, Appealed: Inside the Broken Claims Cycle Draining Medicaid Agencies
This isn't a rare glitch. Denial rates for Medicaid home and community-based services claims routinely run into the double digits, and a meaningful share of those denials have nothing to do with whether the care was delivered.
The Money That Never Comes: Why Medicaid Providers Wait Months to Get Paid for Work Already Done
On paper, Medicaid is straightforward: a provider delivers an authorized service, submits a claim, and receives reimbursement. In practice, the system is anything but. Agencies routinely report six-figure sums sitting in accounts receivable, tied up not because the work wasn't done, but because of how the claims pipeline is built.
The money that never comes: why Medicaid providers wait months to get paid for work already done
Medicaid claims pass through multiple gatekeepers and strict filing windows. Here's why the money takes so long, and what agencies can do about it.
EVV rounding rules: why every state counts your minutes differently
Delaware counts seconds, New Jersey counts minutes, Pennsylvania truncates, Maryland does the math for you — with the state tables side by side.
Reading your remittance: ERA, EFT, and the 835
Matching the deposit to the document, decoding adjustment codes, and the four reads that find money.
Fixing EVV exceptions faster
Daily queues, triage by deadline and dollars, fixing causes instead of symptoms — and the four numbers that tell you it's working.
Why EVV claims get denied
Missed clock-ins, location mismatches, caregiver linkage, authorization problems, schedule mismatches, rounding, and timely filing — plus why exceptions and denials are different problems with different fixes.