What a 98% Clean Claim Rate Really Means in Home Health Billing

How Everest A/R Management Group Turns a Metric Into Measurable Cash Flow

In home health billing, “98% clean claim rate” is often used as a selling point.
But for agency owners, administrators, and CFOs, the real question is:

Does it actually translate into faster payments, stronger compliance, and predictable cash flow?

At Everest A/R Management Group, we work with home health agencies every day that believed they had clean claims — yet still faced delayed payments, silent underpayments, and post-payment audits.

Here’s what a 98% clean claim rate truly means, why most agencies never reach it, and how Everest transforms this metric into real financial performance.

What a Clean Claim Means in Home Health Billing

A clean claim is not simply a claim that gets accepted by the payer.

In home health billing, a true clean claim is one that:

• Is accepted on the first submission

• Requires no correction or resubmission

• Is paid accurately and in full

• Passes medical necessity and documentation review

• Withstands post-payment audits and takebacks

Because home health reimbursement depends on OASIS accuracy, PDGM logic, and documentation integrity, even minor errors can compromise payment long after submission.

Why Many “Clean” Claims Aren’t Actually Clean

Most billing companies define clean claims as “accepted by the payer.”
That definition is incomplete — and dangerous.

Claims may be accepted but later:

• Suspended for review

• Downcoded due to PDGM grouping errors

• Reduced because of late NOA submissions

• Flagged during ADR or UPIC audits

• Recouped months after payment

👉 At Everest A/R Management Group, we define clean claims as: accepted, paid correctly, and audit-safe.

What a True 98% Clean Claim Rate Delivers to Agencies

When a real clean claim rate is achieved, agencies experience measurable operational and financial improvements.

Faster Reimbursements

• Fewer payer suspensions

• Shorter adjudication cycles

• Reduced documentation requests

Lower Days in Accounts Receivable

• AR consistently below 30–35 days

• Less rework and appeal volume

• Faster revenue turnover

Fewer Denials & Takebacks

• Reduced medical necessity denials

• Stronger protection against post-payment audits

• Lower compliance risk

Predictable Cash Flow

• Accurate revenue forecasting

• Improved staffing and growth planning

• Less financial volatility

This is the difference between billing volume and billing performance.

Why Home Health Agencies Struggle to Reach 98%

Even well-run agencies face challenges because home health billing is uniquely complex.

OASIS Accuracy Issues

OASIS errors often:

• Don’t block submission

• Reduce reimbursement later

• Trigger audit exposure

PDGM Grouping Mistakes

Errors in:

• Diagnosis sequencing

• Comorbidity capture

• Admission source selection

can silently reduce payments without issuing a denial.

NOA Timing Penalties

Late or incorrect NOAs:

• Automatically reduce reimbursement

• Are often missed in internal tracking

• Create revenue loss without visibility

Documentation Gaps

Missing or inconsistent:

• Physician orders

• Face-to-face documentation

• Therapy justification

can convert paid claims into future recoupments.

Everest A/R Management Group’s Clean Claim Strategy

At Everest, clean claims are built before billing ever begins.

Pre-Billing Quality Audits

• OASIS validation before claim generation

• Diagnosis and PDGM logic review

• Visit utilization verification

Documentation & Compliance Alignment

• Physician order verification

• Signature and date validation

• Documentation gap resolution before submission

PDGM Optimization

• Accurate admission source selection

• Correct comorbidity pairing

• Therapy threshold and utilization review

NOA & Claim Timing Control

• Automated NOA deadline tracking

• Zero late submission penalties

• End-to-end claim lifecycle monitoring

This approach ensures claims are not only accepted — but paid correctly and protected long-term.

Why Everest’s 98% Clean Claim Rate Is a Financial Outcome

For our home health clients, clean claims result in:

• Reduced rework costs

• Improved margins without increasing census

• Stronger compliance posture

• Sustainable agency growth

At Everest A/R Management Group, we don’t sell metrics.
We deliver results.

What Agencies Should Ask Before Trusting a Clean Claim Rate

Before choosing a billing partner, ask:

• How do you define a clean claim?

• Do you track post-payment denials and recoupments?

• How do you audit OASIS prior to billing?

• How do you ensure PDGM accuracy?

• What is your average home health AR performance?

• How do you protect against audits and takebacks?

If the answers are vague, the clean claim rate is only a number.

Final Thoughts: Clean Claims Are About Precision, Not Speed

In home health billing:

• Speed without accuracy increases risk

• Accuracy without strategy loses revenue

A true 98% clean claim rate means:

• Claims paid correctly

• Compliance strengthened

• Cash flow stabilized

• Agency growth protected

That is the Everest A/R Management Group standard.

🔹 Ready to Strengthen Your Home Health Revenue Cycle?

Everest A/R Management Group delivers specialized home health billing services designed to maximize reimbursement, reduce compliance risk, and improve cash flow.

📩 Contact Everest today to see how clean claims turn into consistent revenue.