Medicare pays less in 2026. The gap is in your AR.
CMS finalized a 1.3% aggregate cut to Medicare home health payment for CY2026, against a payer that is roughly 59% of agency revenue. You cannot negotiate that back. You can collect what is already owed to you.
Patient responsibility collected by 90 days
Collections on the same patient panel, 123 days
Cost to collect, against a 2–3% industry best practice
Said plainly: that was a diagnostic imaging center, not a home health agency. The payer mix is different and we are not going to pretend otherwise. What transfers is the mechanic — a patient balance that ages past 90 days behaves the same way whether the claim in front of it was an MRI or a skilled nursing visit. The 90-day collection rate is the number both sectors live on, and it is the number that moved.
Why this year is different.
The 2026 Medicare cut lands on a thin margin
CMS finalized an aggregate 1.3% reduction to Medicare home health payment for CY2026. Traditional Medicare is roughly 59% of agency revenue. A cut to the majority payer does not get renegotiated. It gets absorbed, and the only places it can come from are cost and collection.
DSO in this sector runs long
Home health agencies commonly sit at 45 to 60 days sales outstanding against a 40 to 45 day benchmark. Every extra day is working capital funding payroll for caregivers who were already paid.
The patient balance is the part nobody works
Deductibles, coinsurance, and non-covered services age quietly behind the Medicare claim. The AR aging benchmark puts 90-plus day balances under 10% of total AR. Most agencies we speak to are well over it and have no systematic process for that bucket.
Referral response time decides who gets the patient
Discharge planners route to whoever answers. An intake process that depends on a person being at a desk loses patients to an agency whose process does not.
Systems, not recommendations.
Every item below exists and runs in production. We are not describing a roadmap.
Patient-responsibility AR recovery
Approval-gated settlement campaigns over SMS and email, risk-scored by payment probability, with every candidate balance and skip reason instrumented. The queue orders itself by who is actually likely to pay.
Inbound message handling
Classifies replies into payment confirmation, link request, confusion, payment-plan request, dispute, stop, and wrong number. Low-risk intents are answered autonomously and payment links are generated on demand. The rest routes to a human with context attached.
Payment plan design
Recommends down payment, installment count, monthly amount, and auto-draft suitability per account, then creates the plan. Tied to execution rather than advice.
Referral intake automation
Capture from fax, portal, and email into a structured intake record. Eligibility and authorization verification before the first visit rather than after the first denial.
Unbilled visit detection
Visits that never made it to a claim are the quietest revenue leak in the sector. Reconciliation between scheduled, documented, and billed surfaces the gap.
Scheduling and coverage
Fill-rate monitoring and same-day coverage gaps, surfaced before they become a missed visit and a service complaint.
Bring us your 90-plus day AR bucket.
A discovery call is a working session, not a pitch. We look at your aging, your payer mix, and your intake path, and tell you where the recoverable money actually is — including when the answer is that there is not enough of it to be worth our fee.
Book a discovery callOperator-built. HIPAA-compliant by default. No PHI leaves your environment without a BAA.