Lens of Grace Advisory

Healthcare Advisory & Executive Coaching

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Consulting Services

You don't need more advice. You need someone who's led inside this.

You're three months from a survey and your documentation isn't ready. Your revenue cycle is bleeding cash from denied claims. Your team is burned out. Your operations are reactive instead of strategic — and you're not sure how to stabilize without losing the people you need most.

You don't need more effort. You need the right system. If your organization is struggling with audits, documentation, billing, or team alignment — you are in the right place.

Who We Work With

  • HCBS / Medicaid waiver providers (CIH, FSW, SFC)
  • Disability service organizations under compliance pressure
  • Leaders overwhelmed by compliance, billing, or operations
  • Home health agencies and adult day services
  • New or growing providers entering the Medicaid ecosystem
  • Founders & small business owners (SBEAP, non-healthcare)

We do not provide services to direct competitors operating in the same service territory and client population.

Small providers don't fail because they lack commitment. They fail because nobody helped them build the foundation.

Situation 01

Your Accreditation Survey Is Coming and You're Not Ready

Who This Is For

HCBS providers facing CQL, CARF, or state survey within 6–18 months who have documentation gaps, staff inconsistency, or unclear compliance systems.

What You Receive

  • Full compliance gap assessment across all survey domains
  • Documentation system redesign and training
  • Mock survey preparation and corrective action planning
  • Staff accountability system aligned to survey standards

$3,500 – $12,000

Depending on scope · Timeline 60–120 days

Situation 02

Claims Are Being Denied and Revenue Is Disappearing

Who This Is For

Organizations with recurring Medicaid billing denials, aging receivables, or revenue that doesn't match the care being delivered.

What You Receive

  • Revenue cycle audit — denial patterns, billing workflows
  • Payer-specific claims correction and resubmission strategy
  • Documentation alignment to billing requirements
  • Staff training on accurate service documentation

$2,500 – $8,500

Most engagements recover more than the engagement cost

Situation 03

You're Hiring Constantly But Can't Keep Anyone

Who This Is For

Organizations stuck in a cycle of hiring, training, and losing staff — where turnover is creating operational instability and compliance risk.

What You Receive

  • Workforce systems audit — onboarding, supervision, retention
  • Job descriptions and performance accountability frameworks
  • Compensation and incentive structure review
  • Supervisory coaching and leadership clarity

$3,500 – $10,000

Scope tailored to organization size

Situation 04

You've Grown, But Operations Feel Chaotic and Unsustainable

Flagship Engagement

Organizations that have grown beyond their original systems and now need full operational redesign to stabilize and scale responsibly.

What You Receive

  • Full 90-day organizational systems diagnostic
  • Compliance, workforce, operations, and revenue cycle
  • 12-month operational roadmap you own permanently
  • Leadership alignment and team accountability systems

$7,500 – $22,000

Most comprehensive engagement · Full organizational transformation

Situation 05

Navigating Medicaid Enrollment, Revalidation, or a Change of Ownership

Who This Is For

New providers entering the Medicaid ecosystem, or existing providers navigating revalidation, CHOW, or NPI/enrollment complications.

What You Receive

  • Application review and enrollment process guidance
  • Documentation preparation and compliance checklist
  • Payer communication support and timeline management

$1,500 – $5,000

Scope based on complexity

Situation 06

Launching or Scaling a Non-Healthcare Business

Who This Is For

SBEAP participants, founders, and small business owners outside the healthcare sector who need clarity, systems, and a real growth path.

What You Receive

  • Business clarity audit (offer, positioning, ideal customer)
  • Financial model review (pricing, margins, cash flow)
  • Operational systems assessment and roadmap
  • 90-day growth action plan

$250 – $3,500

Diagnostic ($250–$750) or full Build Sprint ($1,500–$3,500)

Don't see your exact situation? Most engagements combine elements from multiple areas. Schedule a free 30-minute strategy call — we'll scope and price together.

Not Ready for a Full Engagement?

Start with a free strategy call and a $500–$1,500 Diagnostic Audit. Most clients find a clear path forward from there.

1

Free Strategy Call

Free

30 min · honest assessment

2

Diagnostic Audit

$500 – $1,500

Deep assessment + written report

3

Full Engagement

$7,500 – $22,000

90-day systems transformation

4

Advisory Retainer

$1,000 – $2,000/mo

Ongoing strategic advisory

Full Case Study · 12-Month Engagement

Stabilizing a $7M+ HCBS Organization Under Compliance Pressure

SITUATION

A multi-program HCBS provider serving 170+ individuals was facing simultaneous pressure: approaching CQL accreditation, recurring Medicaid claim denials, high DSP turnover, and operational systems that hadn’t scaled with organizational growth.

WHAT WAS BREAKING DOWN

  • Documentation gaps across 60+ programs
  • Recurring claim denials from billing misalignment
  • High workforce turnover and unclear accountability
  • Reactive compliance posture instead of systems-based prevention
  • $55K–$74K in annual benefit cost waste

WHAT CHANGED

  • $7M+ in organizational revenue stabilized
  • $50K+ in denied Medicaid claims recovered
  • 60+ programs prepared for accreditation survey
  • $55K–$74K annual savings from benefits restructuring
  • BDS corrective action plan completed — 100% on time
  • $5M+ in federal proposal value developed

KEY INSIGHT

The issue wasn’t effort — it was the system. Once the system was aligned, performance followed.

Full Case Study · 90-Day Engagement

Building Compliance Infrastructure for a CARF-Accredited Residential Provider

SITUATION

A CARF-accredited residential disability services provider was operating without foundational compliance systems — no job descriptions, no reconciled billing, and an incomplete state Wellness Plan. Accreditation risk was real.

WHAT WAS MISSING

  • No CARF-compliant job descriptions across any role
  • Billing not reconciled with QuickBooks or San data
  • State-required Tier 2 Wellness Plan not completed
  • No feasibility analysis for planned expansion

WHAT CHANGED

  • 95% audit readiness achieved in 90 days
  • 7 CARF-compliant job descriptions built from scratch
  • Tier 2 Wellness Plan completed — Indiana BDDS compliant
  • Billing system reconciled; staff trained
  • ~30% improvement in documentation efficiency
  • Group home expansion roadmap delivered

KEY INSIGHT

Small providers don’t fail because they lack commitment. They fail because nobody helped them build the foundation.

Full Case Study · 4-Year Engagement

Building a Consumer Brand from Concept to Market

SITUATION

A specialty food startup needed to move from idea to operating business. No brand, no systems, no market validation, no federal certifications. Strong vision — no foundation.

WHAT WAS MISSING

  • No validated market position or customer clarity
  • No brand, website, or marketing system
  • No financial model or operational workflows
  • No path to federal or commercial certification

WHAT CHANGED

  • Full brand, website, and digital presence launched
  • Pricing model, margins, and cash flow built from scratch
  • MBE certified + SAM registered — government vendor eligible
  • Local retail partnerships and community recognition achieved
  • Complete operational infrastructure built and running
  • Experience now embedded in SBEAP coaching curriculum

KEY INSIGHT

Most startups don’t fail from lack of effort — they stall because the foundation isn’t solid. That’s fixable.

Common Questions

Quick answers to the questions we hear most of the time.

What HCBS billing codes are most commonly denied by Medicaid?

The highest-denial billing codes in HCBS Medicaid settings consistently fall into a small set of categories. Companion Care and Residential Habilitation codes (T2016, T2017, H2015) are denied most frequently due to documentation that does not reflect the specific supports provided during the billed shift — notes that say ‘assisted with ADLs’ without naming the activity, the level of prompting used, or the individual’s response. Day habilitation codes (H2012) are denied when attendance records and billing do not match to the minute. Respite care codes (T1005) are denied when the supervising professional credential is not documented in the service note. Personal care codes (T1019, T1020) are denied when the documentation doesn’t distinguish between skilled and unskilled tasks. A revenue cycle audit identifies which codes are driving your specific denial pattern, which staff members have the highest denial rates, and what documentation changes would recover the most revenue. Most organizations carry $10,000 to $75,000 in preventable denials at any given time.

How long does CQL accreditation preparation actually take?

For an organization that has never pursued CQL accreditation, realistic preparation runs 6 to 18 months depending on the current state of your documentation, quality systems, and staff consistency. Organizations with some existing quality infrastructure — regular individual outcome reviews, documented support plans, and a functional incident management system — can prepare in 6 to 9 months. Organizations starting from a lower baseline, or those recovering from a previous failed survey or corrective action plan, typically need 12 to 18 months of structured preparation. The CQL Basic Assurances® require evidence across eight safety and rights domains, while the Personal Outcome Measures® require demonstrated ability to gather and act on outcome data for each individual served. The documentation burden is significant, and mock surveys almost always surface 3 to 7 previously unidentified gaps even in well-prepared organizations. Lens of Grace Advisory’s accreditation readiness engagements run 60 to 120 days and are scoped after an initial compliance gap assessment determines your specific starting point. If your survey is in less than 60 days, contact us immediately — compressed timelines require a different intervention strategy.

Can you help us pass a state survey if we only have 90 days?

Yes — 90 days is workable for most organizations, but it requires prioritization rather than comprehensive reform. The first two weeks are spent conducting a rapid compliance gap assessment to identify which deficiencies pose the greatest survey risk and which can be stabilized in the available time. The middle period focuses on the highest-risk documentation systems, staff training on consistent note completion, and correcting any pending Plans of Correction from previous surveys. The final weeks are spent on mock survey preparation, supervisory walkthroughs, and making sure the physical environment and observable staff practices match what the documentation claims. What a 90-day engagement cannot do is build entirely new systems from scratch — it stabilizes and documents what exists, corrects the most dangerous gaps, and prepares staff for surveyor interactions. The 12-month roadmap delivered at engagement close specifies what infrastructure needs to be built after the survey to prevent the same deficiencies from recurring. Investment for a 90-day compressed accreditation readiness engagement ranges from $3,500 to $8,500 depending on the number of program sites and the severity of identified gaps. Schedule a strategy call as soon as possible — the earlier we start, the more we can accomplish before your survey date.
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