In the high-stakes world of home health care, your billing department is often the difference between a thriving agency and one struggling to keep its doors open. By early 2026, the margin for error has narrowed significantly as CMS and private payers implement more sophisticated, automated audit triggers. Revenue leakage isn’t always caused by large-scale fraud; more often, it is a slow bleed caused by recurring administrative oversights and outdated manual processes.
For agency owners, understanding these pitfalls is the first step toward reclaiming lost revenue. If your “Days Sales Outstanding” (DSO) is climbing or your denial rate is creeping above 5%, you are likely falling victim to one of these ten common billing blunders.
1. Failing to Verify Eligibility Re-determinations
In 2026, patient eligibility is more volatile than ever. Many agencies make the mistake of verifying coverage only at the start of care. However, with frequent shifts in Medicaid redeterminations and Medicare Advantage plan updates, a patient’s “active” status can change mid-episode. Providing services to an ineligible patient is a guaranteed loss that no amount of back-end “scrubbing” can fix.
2. Inaccurate or Incomplete Physician Orders
A “missing signature” is one of the oldest reasons for a claim denial, yet it remains a top reason for revenue loss today. In the current regulatory climate, the “Face-to-Face” (F2F) encounter documentation must be explicit. If the physician’s order lacks the specific frequency of visits or the required clinical depth, the payer will deem the care medically unnecessary, regardless of the patient’s actual condition.
3. Disconnected Electronic Visit Verification (EVV) Data
Since the 2021 mandates, every agency has some form of verification, but the “costly mistake” is keeping that data in a silo. If your billing software and your electronic visit verification (EVV) System are not talking to each other in real-time, you are forced into a manual reconciliation process. This gap often leads to “Record Not Found” denials, where the claim is submitted before the verified visit data has even reached the state aggregator.
4. Overlooking ICD-10 Coding Specificity
The transition to more granular coding continues to catch agencies off guard. Using “unspecified” codes is an immediate red flag for 2026 payers. Coding must reflect the highest level of specificity possible not just the primary diagnosis, but the underlying comorbidities that impact the care plan. High-performing agencies rely on integrated Electronic Health Record (EHR) software that offers built-in coding suggestions and validation to ensure every claim matches the clinical reality.
5. Ignoring Prior Authorization Expiration Dates
Medicaid and managed care plans are notoriously strict about authorization windows. A common error is “service creep,” where care continues for a few days after an authorization has expired but before a new one is secured. Without a system that “hard-stops” scheduling when an authorization is missing, your agency ends up providing free labor that cannot be legally recouped.
6. Poor Management of Manual Visit Edits
High rates of manual edits are the number one trigger for a state audit in 2026. If your caregivers are constantly forgetting to clock in, and your office staff is manually overriding those times, it creates a pattern that looks like “time theft” to an automated auditor. Reducing these edits requires a “Mobile-First” strategy where field staff use reliable Home Health care software that is intuitive enough to use correctly every single time.
7. Submitting Claims Without Pre-Billing Audits
“Submitting and praying” is a recipe for a 20% denial rate. A costly mistake is failing to “scrub” claims for basic errors like mismatched National Provider Identifiers (NPI) or missing ZIP+4 codes before they hit the clearinghouse. Automated pre-billing audits can catch 90% of technical errors that lead to “Rejections” (which are different and often easier to fix than “Denials”).
8. Inadequate Security and HIPAA Lapses
While it may seem like an IT issue, security is a massive billing risk. A ransomware attack that locks your billing files for two weeks can effectively bankrupt a mid-sized agency. Beyond the tech, failing to use HIPAA Compliant Software for internal messaging and document sharing puts you at risk for massive OCR fines that will wipe out your year’s profits in a single stroke.
9. Slow Response to Denials and ADRs
An “Additional Documentation Request” (ADR) is not a suggestion; it is a time-sensitive demand. Many agencies fail because they don’t have a centralized way to track denials. When a claim is denied, the clock starts ticking. If you don’t resubmit within the payer’s window, that revenue is gone forever. Real-time dashboards are essential for tracking the status of every “pending” claim.
10. Failing to Scale with Unified Technology
The biggest mistake is staying small in your thinking. Running an agency on paper, spreadsheets, and three different software logins is no longer sustainable. To thrive, you need a single source of truth. Moving your operations to a comprehensive platform like myEZcare ensures that your scheduling, clinical notes, EVV, and billing all exist in one cohesive ecosystem, eliminating the data gaps that cause 90% of these costly errors.
Frequently Asked Questions (FAQ)
What is the difference between a claim rejection and a claim denial?
A rejection happens at the clearinghouse level due to technical errors (like a typo in an NPI number) and can often be fixed and resubmitted immediately. A denial happens at the payer level after the claim has been processed, usually due to clinical or authorization issues, and requires a formal appeal.
How often should my agency check patient eligibility?
In 2026, the best practice is “Every Visit, Every Time,” but at a bare minimum, eligibility should be verified at the start of every month and again mid-month for Medicaid patients to account for redetermination cycles.
Can EVV really prevent billing audits?
EVV itself doesn’t prevent an audit, but clean EVV data is your best defense. If your clock-in/out locations match the patient’s home and the times match the billed units, an auditor has very little ground to stand on for recoupment.
Why are “unspecified” ICD-10 codes being denied more frequently?
Payers are using AI to identify claims that lack clinical complexity. They believe that if a diagnosis is “unspecified,” the agency hasn’t done a thorough enough clinical assessment, which they then use as a reason to question the medical necessity of the entire episode.
How can I reduce the administrative burden on my billing team?
The most effective way is through integration. When your EHR, EVV, and Billing software are one system, the billing team no longer has to “enter” data; they simply “review” it, allowing them to focus on high-value tasks like managing appeals and ADRs.
