Margin has no slack left
Permanent behavioral cuts keep stacking. Agencies cannot cut their way out. The remaining lever is capturing what was already earned.
Pre-submission revenue integrity
Stop finding the money after the claim goes out.
Upheld is the pre-submission layer for Homecare Homebase. It catches case-mix and utilization errors before the claim is submitted—not after the audit returns.
Not an EMR · Not a coding outsourcer · Not another QA dashboard
3.6×
Value multiple
3.3 mo
Payback period
262%
ROI on software
$302k
Net year-one benefit
Illustrative model · multi-site Medicare HHA · ~600 ADC · current CMS rates
Why now
Three forces converged. None of them reverse.
The rules moved again
PDGM weights, functional levels, comorbidity subgroups, and LUPA thresholds recalibrated. Human QA does not recalibrate annually. Software does.
Documentation drives turnover
OASIS plus a comprehensive assessment often runs 90–120 minutes. Reducing friction is a retention play as much as a revenue play.
Product
The layer that acts before submission
Everyone else finds leakage after the claim is gone. Upheld closes the gap between the error and the moment it can still be fixed.
Built to sit alongside Homecare Homebase—no migration, no replacement of the system of record.
Full OASIS scrub
Ninety-one item assessment checked against current case-mix, functional, comorbidity, consistency, F2F, and homebound rules.
Live reimbursement preview
HIPPS-style code and thirty-day period payment for agency administrators as the assessment is completed.
LUPA threshold alerts
Day-twelve style utilization alerts while the schedule can still be fixed—not on remittance advice.
Exception-based QA
QA works what was flagged instead of every line. That is where the labor savings originate.
HCHB write-back
Pull assessments from Homecare Homebase, scrub in Upheld, push corrected items back. HCHB remains chart of record.
ICD-10 guided coding
Searchable diagnosis library with M1021 description hints tied to documented clinical evidence—not optimization theater.
ROI of implementing Upheld
Invest $115k. Recover $417k. Keep $302k.
First-year model for a multi-site Medicare home health agency at approximately 600 average daily census. Returns are calculated against software subscription only.
Investment
$103,488
Enterprise annual contract
$9,800 per month · unlimited branches · HCHB integration path
Annual value
$416,900
Gross benefit year one
~4.8% of traditional Medicare book · documentation-backed only
Net return
$313,412
Value minus software cost
303% ROI · 4.0× multiple · 3.0 month payback
Implementation ROI
ROI = (Annual value − Software ACV) ÷ Software ACV = ($416,900 − $115,200) ÷ $115,200 ≈ 262%
Payback = ACV ÷ monthly value = $115,200 ÷ $34,742 ≈ 3.3 months
Value composition
Defensible lines for a first CFO conversation—nothing that requires stretched assumptions.
| Driver | Annual | Share |
|---|---|---|
| Case-mix accuracy recovery | $99,800 | 24% |
| LUPA prevention | $112,600 | 27% |
| QA / coding labor reclaimed | $112,300 | 27% |
| Clinician documentation time returned | $55,600 | 13% |
| Denial exposure avoided | $28,000 | 7% |
| Working capital released | $8,600 | 2% |
| Total annual value | $416,900 | 100% |
Cost of implementing
- Enterprise ACV
- $115,200
- HCHB migration
- $0
- New EMR / stack training
- $0
- Total software cost
- $115,200
Sits alongside Homecare Homebase. No system-of-record change. Pilot branch can go live in days—not a nine-month IT program.
CFO summary
Every $1 spent on Upheld returns about $3.60 in recovered revenue and reclaimed labor in year one—with payback before month four.
262%
ROI
3.6×
Multiple
3.3
Months
Held out of the first model
- RN turnover reduction
- HHVBP payment adjustment lift
- Referral share from faster SOC
Real upsides—reserved for the second meeting so the opening model stays defensible.
Time to value
1Days 1–30
One-branch pilot live. Pull from HCHB, scrub, measure recovery per period.
2Days 31–90
Prove catch rate against a written success metric. Expand or walk.
3Month 4
Payback complete on Enterprise ACV at model rates.
4Month 12
Approximately $302k net retained after software cost.
Pricing
Cost that scales with value—not ahead of it
Branch-by-branch rollout. Paid pilot with a written success metric before day one. Annual billing saves 12%.
Most agencies recover 3–4× the annual fee in year one
Start hereStart Pilot
Proof Pilot
Single-branch proof
$1,750/month
Annual $18,480 · save 12%
1 branch · 90 days
- Full OASIS-E1 scrub
- Live reimbursement preview
- LUPA threshold alerts
- Exception-based QA queue
- HCHB pull + write-back
- Recovery & impact reporting
- 100-record retrospective scrub (included once)
Support: Standard support
Contract: 90-day paid pilot
Growth
Multi-branch agencies (≈200–500 ADC)
$6,500/month
Annual $68,640 · save 12%
Up to 5 branches
- Everything in Proof Pilot
- ICD-10 guided coding support
- Volume-banded assessments
- Quarterly rate-table updates
- 100-record retrospective scrub available
Support: Priority support
Contract: Month-to-month or annual
Enterprise
Multi-site / unlimited scale
$9,800/month
Annual $103,488 · save 12%
Unlimited branches
- Everything in Growth
- Dedicated success partner
- BAA + security pack
- 100-record retrospective scrub included
Support: Dedicated support
Contract: Annual preferred
All plans include annual CMS rate-table updates as a pure data change — no software release required.
Need a right-sized plan for <200 ADC? Contact us for hybrid pricing.
Optional usage add-on
For agencies that prefer lower fixed cost + volume alignment. Platform fee starting at $3,500/month + $4.50 per assessment (or per 30-day period). Volume discounts available above 400 assessments/month.
Usage pricing
$3,500 + $4.50
platform + per assessment
Built for operators
Multi-site Medicare home health, by design
CFO / VP Finance
“You are leaving roughly 4.8% of your Medicare book on the table. Here is the model.”
VP Clinical Operations
“Your QA team stops reading every OASIS line by line and starts working exceptions.”
Chief Compliance Officer
“Face-to-face and homebound completeness is checked at documentation—not on appeal.”
CIO / VP IT
“We sit alongside HCHB. No system-of-record replacement. No forced migration.”
Economic buyer: CFO · Champion: Clinical operations · Early veto to neutralize: Compliance
Where alternatives lose
| Alternative | Their pitch | Gap |
|---|---|---|
| In-house QA | “We review everything” | Does not recalibrate to CMS rates or scale |
| Outsourced coding | “We code it for you” | Post-submission · linear cost forever |
| HCHB native tools | “Already in the platform” | Capture & compliance, not recovery |
| RCM analytics | “We find leakage” | After the claim · reporting ≠ recovery |
The wedge: everyone else operates after submission. We act before it.
FAQ
Clear answers for a careful buyer
Our QA team already catches this.+
A 100-record retrospective scrub costs you nothing and proves it. If we find under 5%, walk away. We have never seen under 5%.
This sounds like upcoding.+
It is the opposite. We flag over-coded items with the same rigor as under-coded ones. Every flag traces to documented clinical evidence. Defensible accuracy is the product.
We cannot add another system for clinicians.+
We sit alongside Homecare Homebase and write corrections back. Pilot is scoped to one branch. No long-term parallel charting workflow.
IT will take nine months.+
Read-only pull first, BAA before pilot, no migration, no change to the system of record. Live write-back via partner gateway when ready.
How is pricing structured?+
Proof Pilot at $1,750/month (90-day single-branch), Growth at $6,500 (up to 5 branches), Enterprise at $9,800 (unlimited). Annual billing saves 12%. Optional usage add-on: $3,500 platform + $4.50 per assessment. Hybrid pricing available under 200 ADC.
Every 30-day period priced before you submit it.
Explore the Prairie Home Health demo with full OASIS, QA, LUPA watch, and HCHB write-back—or start a 90-day paid pilot on a single branch.
Demo: nurse@ · qa@ · cfo@demo.local · password123