I want to walk you through a real engagement — anonymized, but real. The organization was a group home serving adults with intellectual and developmental disabilities under the Maryland DDA. They had been operating for two years. They genuinely cared about their residents. And they received a monitoring visit that resulted in a 14-item deficiency report. Fourteen items. In a single visit. When they came to me, the owner was overwhelmed and honestly scared. She did not know how to respond to the deficiencies, which ones were most serious, or how to prevent this from happening again. Here is what we found when we dug in: The most critical deficiencies were documentation related. Person-centered plans were not being updated on schedule. Incident reports were being filed internally but not escalated to DDA within the required timeframe. Medication administration records had gaps. None of these were intentional. They were the result of a staff team that had never been formally trained on compliance documentation requirements, and a supervisor who was managing by instinct rather than written procedures. Here is what we did: First, we prioritized the deficiencies by severity and wrote a Corrective Action Plan with specific responsible parties and dates for each item. Second, we revised the policies and procedures to reflect the correct processes — not what the template said, but what the staff would actually be trained to do. Third, we conducted a half-day training with the full staff team on documentation standards, incident reporting timelines, and person-centered plan requirements. Fourth, we built a compliance calendar with scheduled internal audits every 30 days for the first quarter. At the 90-day follow-up visit, all 14 deficiencies had been addressed. The organization received a clean monitoring report. The problems were fixable. They always are. But you have to know what you are fixing and why. If your organization has received a deficiency report or is worried about an upcoming survey, drop a comment or DM me. This is exactly what I do.

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I have worked with enough home care agency owners to know something clearly: Success in this industry is not about who has the best clinical background. It is not about who has the most connections or who came from money. It is almost always about one thing: where you spend your time. The agency owners who stay stuck are almost always the ones who are running their businesses instead of building them. They are doing the scheduling because they do not trust the process they built. They are personally handling every client complaint because they have not developed their staff to handle them. They are going to every single state training, audit meeting, and networking event because they believe that if they are not there, it will fall apart. Meanwhile, the ones who scale are deliberate about what only they can do — and they get everything else off their plate as fast as possible. As the CEO of your agency, your job is strategy, relationships, and compliance oversight. Not operations. That does not mean you ignore operations. It means you build systems, document processes, and develop people to run them — so you can focus on what actually moves the business forward. One question worth sitting with today: What did you do in the last 7 days that only you could have done? If the honest answer is "not much," that is the work. Not more hustle. Better architecture. What is one thing you are still doing yourself that you should be systematizing or delegating? Drop it below.

Most agency owners sign MCO provider agreements without fully understanding what they are agreeing to. I understand why — these documents are long, written in legal language, and you are usually eager to just get contracted. But what is in that agreement will govern your entire relationship with that MCO. Here is how to read one properly. Step 1: Find the termination clause. Before anything else, understand how either party can end the relationship. Look for language about "without cause" termination — this is common, and it means the MCO can end your contract with as little as 30 or 60 days notice for any reason. Know this going in. Step 2: Read the covered services section. This tells you exactly which service codes you are authorized to bill under this agreement. Do not assume that because you are licensed to provide a service, the MCO will pay for it under this contract. If it is not listed, you cannot bill it. Step 3: Understand the billing and payment terms. Look for timely filing limits (usually 90 to 365 days from the date of service), claim submission requirements, and the dispute resolution process for denied claims. Missing a timely filing deadline means you eat that claim — no exceptions. Step 4: Find the audit and record retention requirements. Most agreements require you to retain records for 6 to 10 years and to make them available to the MCO or state agency on request. Understand what that means for your documentation practices. Step 5: Look for the compliance requirements. Many MCO agreements now require you to have a written compliance program, a code of conduct, and HIPAA policies in place. If you do not have these and you signed saying you do — that is an exposure. Read it. All of it. Or have someone read it with you. Have a provider agreement you need to review? Drop a comment or DM me. I do contract review as part of my consulting services.

Everyone focuses on the credentialing application. The paperwork, the enrollment, the waiting, the approval. And yes, that process is real and it matters and I have helped a lot of agencies get through it. But here is what nobody tells you about what happens after you get approved: MCOs re-credential you. Every two to three years, depending on the plan. And if you miss their recredentialing request — which often comes in as one letter to an address that may have changed, or an email that got buried — your contract gets terminated. Quietly. Without a phone call. You find out when a claim gets denied. Beyond recredentialing, MCOs also monitor your compliance status. Complaints filed against your agency. Survey deficiencies with the state. Licensing actions. Any of these can trigger a contract review or termination. And then there is utilization. MCOs track whether you are actually serving members. If you are approved but dormant — no claims, no active clients under that plan — some plans will pull your contract to free up their network capacity. Staying on a panel requires the same intentionality as getting on one: Keep your contact information updated with every MCO you contract with. Calendar your recredentialing dates two months in advance. Submit claims consistently once you are approved. Keep your compliance record clean. The agencies that build sustainable businesses treat their MCO relationships like business partnerships — not checkboxes they completed once and forgot about. Do you know your recredentialing dates for each MCO you are contracted with? Drop a yes or no below.