How to Maximize Unclaimed Revenue in Home Health Care

How to Maximize Unclaimed Revenue in Home Health Care

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Erin Cahill: Hi, Keith, how are you?

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Keith Grunig: Good morning. How are you?

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Erin Cahill: I’m doing well. Thanks. Did the team provide you with the questions for today?

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Keith Grunig: Yeah, I think so.

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Erin Cahill: Okay, perfect. So, everything’s all right on your end.

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Keith Grunig: I believe so, unless something goes sideways.

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Erin Cahill: Okay, perfect and I just want to make sure I’m saying your name right as well. How do you say your last name?

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Keith Grunig: Grunig.

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Erin Cahill: Grunig. Okay, perfect. All right, that’s great. So that’s a recording. So, I’ll jump right into it.

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Erin Cahill: So welcome to CareSmartz360 On Air, a Home Care Podcast. I’m Erin Cahill, a Senior Sales Consultant at Caresmartz. Today, we’re diving into a topic that could have your revenue charts looking a whole lot healthier—unclaimed revenue in home health care! And who better to help us uncover hidden financial gold than Keith Grunig?

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Erin Cahill: Keith isn’t just crunching numbers—he’s making them work for home care businesses. As the Vice President of Sales and Marketing at Home Care Answers, he’s a C-suite powerhouse overseeing everything from sales and marketing to business strategy and competitive positioning. This guy doesn’t just forecast—he practically predicts the future, landing within 4% of his revenue forecasts like some kind of data analytics wizard.

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Erin Cahill: He’s tripled, even octuplet, daily revenue, mastered the art of reengaging former clients, and turned Home Care Answers into a Google-ranking powerhouse. Oh, and did I mention a 90% close rate after a trial? So, if you’re leaving money on the table, Keith’s here to help you pick it up. Let’s talk about maximizing revenue!

Welcome to the Podcast, Keith.

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Keith Grunig: Well, thank you.

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Erin Cahill: So, we’ll jump right into it. 1st question for you. Billing errors and denied claims are a major source of lost revenue. What strategies can agencies use to reduce denials and streamline reimbursements.

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Keith Grunig: Well, that’s a big question that we could spend a lot of time on that. Really.

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Keith Grunig: as you look at it. It’s got to start with compliance in the very beginning.

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Keith Grunig: because if we’re down to the if we’re down to the billing and we have an issue. There’s a lot of things that have happened before that we’ve got to get that need to be straightened out hopefully up front so that we can clean it up, so we don’t have to clean it up later, for example, in home health intake. Do they have a checklist of everything that they need to have in order to accept that patient? And are they adhering to that?

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Keith Grunig: And we’ve got a lot of marketers out there that are happy to bring clients on, but maybe they’re not. They might not share with the referral partner. Hey? Here’s what we need to be able to take this patient on

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Keith Grunig: right? So, intake’s got to help with that.

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Keith Grunig: The other part is, we’ve got to have beginning of the episode.

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Keith Grunig: accuracy, and that starts again with intake. But Medicare right now, the number one reason why claims are still denied. Is it non-compliant or

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Keith Grunig: incorrect, face to face?

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Keith Grunig: So that’s just low hanging fruit.

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Keith Grunig: and it this face to face isn’t signed by the doctor. The primary diagnosis is not related, or it’s the coding is incorrect or not related to the primary focus of care.

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Keith Grunig: or the or the referral reason. And doctors aren’t very good frankly all the time, because they don’t know the rules of home health to be able to

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Keith Grunig: share or adequately say what the reason is like. For example, doctors are for

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Keith Grunig: patients for weakness all the time. Well, weakness is not a Pdgm compliant diagnosis code that can’t be the primary diagnosis. Weakness will get you $0 from Pdgm from Cms from Pdgm purposes. So, we’ve now got to tie. What’s causing that weakness?

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Keith Grunig: Is it an infection? Is it.

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Keith Grunig: dementia? Is it? What is the reason for the underlying cause of that condition? And then we can code from there. So sometimes, if we can help the doctor understand that maybe the doctor can help us, or we have to go back to the doctor and say, this doesn’t work. Here’s a diagnosis. Is this the underlying cause? And then the doctor can sign it and say, yes, that’s the underlying cause. Off we go.

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Keith Grunig: But if the face to face isn’t correct from the get.

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Keith Grunig: Cms is going to deny right there. Boom!

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Keith Grunig: So that’s low hanging fruit for CMS and auditors to get.

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Erin Cahill: yeah, no. That makes sense. And what are some effective strategies? Agencies can use it to reconnect with past clients and drive new revenue streams.

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Keith Grunig: So, I look at it from a couple like I look at it from

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Keith Grunig: a few different ways. But really there’s 3 ways that agency, or that any business can kind of

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Keith Grunig: gain or improve revenue. 1st one is existing clients.

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Keith Grunig: is that what can we do to increase our revenue with existing clients is that upselling is that cross selling? But we also have to be smart and careful about that, because if we’re if we’re only contacting our client partners.

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Keith Grunig: with opportunities to make more money. They get tired of that.

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Keith Grunig: like, how are we helping them, and only offer what’s going to bring what we think is going to bring value, and sometimes we just have to let it sit and say, all right, we’re working on it. We’ll talk to them a little bit later, or Hey, when you get a minute, I’d like to talk to you something about something that we’re that we’re working on, that I think will help you

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Keith Grunig: in the long run. But if we’re if they’re only a target of our revenue, then that’s not really partner us. We’re using them, and I don’t think that’s a very long term.

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Keith Grunig: Positive strategy for for partner or me or me. The second one is old clients. How do we reach back to old clients

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Keith Grunig: that we have existing relationships with

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Keith Grunig: some people. They just move on for a different reason. So sometimes there’s leadership change. Who knows why?

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Keith Grunig: they maybe there’s a contract issue. Who knows.

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Keith Grunig: but most of the time people leave on pretty good terms, and you just keep you just keep it warm.

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Keith Grunig: You talk to him. How is it going? And we’re doing it in a genuine manner like I. Honestly, you’re my friend while you were my client. So you’re still my friend, when you’re not my client, how are you doing? What’s new? Anything, anything we can do? Is there a way to at some point would you consider coming back?

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Keith Grunig: And then we let them know of the

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Keith Grunig: upsell or the additional things that we’re that we’re doing to help agencies. We keep them informed, so that at some point they might come back.

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Keith Grunig: But it’s easy to re. It’s easy to rewarm the conversation with a friend

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Keith Grunig: rather than just start a cold started at a cold lead, and see where that goes.

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Erin Cahill: Right.

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Keith Grunig: Efficiencies is pretty good. And then we have, you know, obviously cold outreach, which is just normal. How do we do this cold calling? Not the most effective. But sometimes what’s what we have to do? And the 3rd one is new revenue streams. So what are we doing to not necessarily leave our core business. But how do we augment our core business through different revenue streams? Maybe it is, hey? We identified a problem.

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Keith Grunig: that agencies are having, and we can do it for free.

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Keith Grunig: which then is just an add value, or this is like we. It might cost something, because it adds a cost to me.

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Keith Grunig: But if there’s new revenue streams, hey? Look we, we’re really good at this.

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Keith Grunig: Maybe we look at.

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Keith Grunig: adding training. Maybe we look at adding something else that that just rounds out what we’re what we’re trying to offer.

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Keith Grunig: So that’s probably 3 ways that I would suggest.

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Erin Cahill: I’m doing that.

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Erin Cahill: Yeah. And from your experience, what specific compliance challenges do home health agencies face in Utah? And how can they say ahead of regulatory changes.

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Keith Grunig: So

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Keith Grunig: I would broaden that even further from Utah CMS has national rules. So, home health we’re abiding by Federal rules. So, everybody’s pretty much on the same plane, on the same playing field, which is a good thing. I go back to face, and the other thing I look at. You know, there’s agencies have got a lot of things going on specifically home health agencies, skilled care, medical.

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Keith Grunig: There’s a ton of regulatory changes. There’s changes every year. There’s staffing challenges. All medical staff understand that home health Hospice.

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Erin Cahill: Home care. That’s non-medical. There’s staffing challenges, which is.

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Keith Grunig: There’s even some challenge. There’s even some issues with non-skilled going. The 80 20 rule that they’re

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Keith Grunig: they’re proposing. We don’t know where that’s going to go.

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Keith Grunig: but there’s a lot of regulatory changes

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Keith Grunig: with staffing challenges. That means we’ve got fewer people to do things fewer people to keep eyes on things, fewer people to be informed about what’s happening. So that’s a real issue that doesn’t necessarily even deal with being able to deliver care. It’s how many people can we throw it through at an issue and be aware and be informed of it?

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Keith Grunig: There’s budget challenges. How much money do would do. Agencies have to track that by themselves.

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Keith Grunig: Everything has a cost

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Keith Grunig: there. There’s going to be a line item cost somewhere. It doesn’t look like a cost. But how much time are we spending?

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Keith Grunig: I have to spend X amount of time looking at regulatory issues. There’s going to be a cost to that. Is that worth that cost? Or do I can. I maybe have somebody else help me look at regulatory issues while I’m focusing on something else. There’s things to do that, for example, coding we do coding and oasis for skilled agencies, and there’s coding updates every year.

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Keith Grunig: and if an agency most agencies, I’d say most.

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Keith Grunig: They don’t have the bandwidth or the salary, or the expertise to have an in-house coder anymore. It’s too complicated. So if they just a smaller agency’s got one coder.

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Keith Grunig: They have to send them to training. They have to do this. What happens when they get sick? What happens if they go on vacation. They get burned out. They’re always behind cash flow starts to lag. There’s a lot of things, or partner with somebody that’s already we’ve got to do the regulatory compliance. We’re doing the regulatory training. We’ve got the help we’re tracking that for them, so they don’t necessarily have to worry about it, and then we keep them informed of. Here’s the changes that are coming or have started. We’ve on top of it just something for you to be aware, or there’s a new.

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Keith Grunig: We have oasis, e, 1 that just started this year that that was not a that wasn’t a major change

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Keith Grunig: to

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Keith Grunig: from oasis E. There’s a couple of questions that went away. There’s 1 new question, but we’ve got that under control. We’re just telling them. Here’s what it is. We’re looking at the final rule, and we’re going to give them the heads up of. Here’s what’s changing. They’re obviously going to be aware of it because they have. You can outsource a lot of things, but you can’t outsource accountability.

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Keith Grunig: So we’ve still got to be accountable to what

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Keith Grunig: is happening. But we partner with the right people to help them

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Keith Grunig: to keep us aware, like, we can’t be an expert in everything.

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Keith Grunig: So we work with the right people to get it right.

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Erin Cahill: And how can AI and advanced analytics help agencies recover lost revenue and improve financial forecasting.

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Keith Grunig: So that one’s kind of a tricky one. Ai is pretty new.

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Keith Grunig: We’re kind of waiting to see what we’re obviously working with it. But AI is only as good as what feeds it.

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Keith Grunig: So if we’re feeding it, the incorrect information, then it’s going to give us back incorrect information. Now, I think there’s some good places for AI with repetitive things that here’s a very repetitive process that happens. Can we automate that to reduce human touch and human time, and then the human still is going to look at it and say, yes, that passed the sniff test

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Keith Grunig: that that we can help. We’re seeing some AI that’s trying to perhaps replace

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Keith Grunig: human intelligence. And we’re seeing a crossover with that. And we’re not sure where that’s going to go. Frankly.

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Erin Cahill: But AI can help.

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Keith Grunig: Make processes easier to make it more predictable.

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Keith Grunig: But we’re not ready to say it’s able to do a clinician’s job for it.

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Keith Grunig: And if clinicians are thinking, AI is going to do their job for them.

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Keith Grunig: then it’s probably then then we’re probably gonna have an issue.

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Keith Grunig: Yeah, because, because, like, it’s only as good as the information we feed it.

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Erin Cahill: Right? Yeah. Still, early days.

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Keith Grunig: Well, it’s just- just.

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Keith Grunig: It’s a machine. It doesn’t make clinical judgment calls it doesn’t. It doesn’t have intuition. It doesn’t read between the lines. It’s not. It’s not using a decades of experience and saying, All right, here’s a pattern I’m seeing somewhere else. I’m going to apply that here. What does that look like? We’re just not there yet. And that’s okay.

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Erin Cahill: Yeah, absolutely. And then last question for you. Looking ahead, what major trains or regulatory changes do you foresee in 2025 that could impact home health agencies, revenue streams.

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Keith Grunig: Boy, the one the one that is glaring right now is value based purchasing. That’s the one that I’m seeing

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Keith Grunig: that it’s helping some agencies, and it’s hurting some agencies. There’s some agencies that still aren’t aware of their value-based purchasing impact. So a few years several years ago, CMS. Came out and said, We’re going to do value-based purchasing. We’ve been trialing it in some States. We’re going to give it to everybody and based on measures. There’s oasis measures. There’s process measures keeping people out of the hospital. And then there’s basically client measures to say how happy are they.

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Keith Grunig: They’re doing all those 3 things, and then they come up with a score, and depending on that score they can be they CMS will take away 5%, or they’ll give them up to 5%

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Keith Grunig: of their revenue. So agencies could take a 5 5% haircut, or they could get a 5% raise. And most of it’s kind of it’s centering towards plus or minus one plus or minus 2 with within.

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Keith Grunig: I will call it standard deviations for lack of a better term. It’s kind of clustering to the middle. However.

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Keith Grunig: there’s agencies that are just figuring this out. They’re just finding it out now. So, and that information was from 2 years ago.

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Keith Grunig: So 2023 impacted 2025, payment, 2024 impacts, 2620, 26 payment. But that’s already baked agency. There’s not a whole lot we can do to change that. And so we’re seeing some agencies. They’re looking at a 3 or 4% decrease. And they just found out this year.

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Keith Grunig: like they, we sent out an email to our clients and said, Here’s what

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Keith Grunig: we’ve got like. Look at your value based purchasing scores and what what’s it looking like? And some are like, I don’t even know what you’re talking about, and I don’t know where to find it.

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Keith Grunig: And so

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Keith Grunig: here we are. And now they can’t change anything. We’re just looking at a 3% cut boom.

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Keith Grunig: Some are higher, some are lower, but that’s not a pleasant surprise to find that one

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Keith Grunig: so 2027. So right now, in 2025, here we are, middle of February

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Keith Grunig: 2027 payment is being impacted this year right now.

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Keith Grunig: So agencies can proactively manage. And there’s been several changes to value-based purchasing

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Keith Grunig: from last year to this year. So, being aware of what’s going on

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Keith Grunig: being able to impact or change

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Keith Grunig: or plan, how am I going to? How am I going to offset this or influence it for better, because we can. If we get better outcomes.

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Keith Grunig: then we’ll get better reimbursement in 2027. So we’re looking forward on, how do we do that

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Keith Grunig: now?

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Keith Grunig: From our perspective, we got to get it right. If oasis is right at the beginning we got a much better chance of helping people at the end. But if it’s not right, then we don’t have a whole lot of room to improve and show improvement upon discharge. So then they’re kind of shooting themselves in the foot. And they don’t realize it. What we’re doing is highlighting. Here’s areas where we can improve. Here’s areas where you guys can improve. And now we’re showing the we’re giving people the chance to improve rather than

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Keith Grunig: the oasis score doesn’t allow for that. And that’s often underscored, frankly based on what’s going on with the patient. They got the following diagnoses. They weren’t independent, but the initial scoring said they are independent. They broke their leg. They’re not independent, they never were independent.

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Keith Grunig: So now how do we show improvement? If it starts an independent, we don’t.

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Keith Grunig: So that’s a big, regulatory thing that we’ve got, that the agencies need to be aware of and proactively manage going forward so that they can give themselves a shot to not continue to have tough times and unnecessary haircuts.

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Keith Grunig: by their own doing. We’re going to struggle with cost, with rate decreases from CMS in the near future. Because there’s just

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Keith Grunig: there’s not some big pot of money that says, hey, we’re going to. Just oh, magically, give you 5% of the data we’re showing them. Say, we’re trying to cut costs.

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Keith Grunig: You look at your cost reports. They’re cutting cost. And so, guess what CMS is doing. You’re cutting costs. We’re going to cut your reimbursement.

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Keith Grunig: So, it’s a self-fulfilling prophecy. If we continue to do what we’re doing without having data to support that.

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Keith Grunig: Cheapest, isn’t always the smartest.

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Erin Cahill: Yeah, absolutely! Well, thank you so much, Keith, for sharing your expertise with our lovely audience. Thank you so much for tuning in until next time. I’m Erin Cahill signing off.