Home care billing workflow and receivables tracker
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Work through twenty-nine billing habits in six groups, from setup to the weekly receivables review. Each item names its source, points you to your payer or state, or is marked as your own planning. It shows counts only; it does not score you or predict payment.
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Mark each item Done, In progress, Not yet or Does not apply. Blank items stay Not checked.
A. Setup
1. A written list of the payers you accept: private-pay clients, and only those Medicaid, waiver, managed care, insurance or other payers you are actually enrolled with or contracted by.
Your own planning
2. A private-pay rate sheet you set and own, and for each payer a copy of the rates in your contract or the payer’s own published schedule. This site does not publish rates.
Your own planning; Check your payer contract or provider manual
3. An invoice template for private-pay clients, and for each payer the claim format and submission method its contract or provider manual names.
Your own planning; Check your payer contract or provider manual
4. Payment terms written into each private-pay service agreement: what is billed, how often you invoice, when payment is due, how clients can pay, and what happens when a payment is late. Review the wording with counsel.
Your own planning
5. One named person who owns billing week to week, and a backup for when that person is away.
Your own planning
6. If HIPAA applies to your agency, a business associate agreement with any billing company or vendor that handles protected health information for you. Decide with counsel.
Source: HHS OCR, HIPAA covered entities and business associates; HHS OCR, Business associates
B. Document before you bill
7. Visit verification for every shift you bill: a timesheet or visit record showing who provided the service, for whom, on what date, and when it started and ended.
Your own planning
8. Care notes or task records for each visit, in the form your state licensing rules or your payer require.
Check your state Medicaid agency; Check your payer contract or provider manual
9. An authorization on file before you serve a client whose payer uses authorizations, with the approved services and units noted, and a reminder set before it ends.
Check your payer contract or provider manual
10. EVV capture for each visit if your program requires it. Your state Medicaid program sets the EVV method; federal law does not require one uniform system.
Source: Medicaid.gov, Electronic Visit Verification; CMS, EVV FAQs (Cures Act section 12006); Check your state Medicaid agency
C. Create the invoice or claim
11. Private-pay invoice fields: client and responsible party, service dates, hours or visits, your rate, any agreed charges, the total, the due date and how to pay.
Your own planning
12. A check that each invoice or claim matches the visit records: dates, hours, caregiver and client all agree.
Your own planning
13. Payer enrollment in place before you bill that payer. For Medicaid, becomemedicaidprovider.com, also published by Home Care Agency Blueprint, covers enrollment.
Check your payer contract or provider manual
14. The payer’s own claim instructions: the format, the identifiers it asks for, and the service codes and units in its manual or contract. This site does not teach coding.
Check your payer contract or provider manual
15. If you send claims electronically, the HIPAA standard transactions your payer or clearinghouse uses for claims, claim status and remittance advice.
Source: CMS, HIPAA standard transactions
D. Submit and confirm
16. A check of the client’s coverage or eligibility with the payer before you bill, when the payer offers one.
Source: Check your payer contract or provider manual; CMS, HIPAA standard transactions
17. Each invoice sent, or claim submitted, by the method the client agreement or payer names.
Your own planning
18. Confirmation that the invoice or claim arrived: a payer acknowledgment, a claim status check, or a reply from the client.
Source: Check your payer contract or provider manual; CMS, HIPAA standard transactions
19. A billing log with the date each invoice or claim was sent, who it went to, what was billed and its status.
Your own planning
E. Follow-up and aging
20. A day-7 check on every open invoice or claim: confirm it was received and nothing is missing. The checkpoint days are your own choice.
Your own planning
21. A day-14 follow-up on anything still open: a polite written reminder to the client, or a claim status check with the payer.
Your own planning
22. A day-30 review of anything still unpaid: the owner sees it, someone calls the responsible party or payer, and the next step is noted.
Your own planning
23. A log of every denial, rejection or returned claim, with the reason the payer gives and who is fixing it.
Check your payer contract or provider manual
24. Corrected claims or invoices resubmitted the way the payer’s instructions say, with the resubmission date logged.
Check your payer contract or provider manual
F. Cash application and close
25. Each payment matched to the invoice or claim it pays, using the payer’s remittance advice or the client’s payment note.
Source: Your own planning; CMS, HIPAA standard transactions
26. Partial payments recorded against the right invoice, with the open balance carried forward and a note on why.
Your own planning
27. Private-pay and payer balances kept in separate, clear ledgers for each client, so nothing is billed twice or missed.
Your own planning
28. A written approach to balances you decide not to pursue, set in your own planning with your accountant or counsel.
Your own planning
29. A weekly receivables review: open items by aging bucket (current, 30, 60, 90 and 90-plus day), the next step for each, and who owns it.
Your own planning
Planning aid only. Not billing, tax or legal advice. Payer rules vary.
How to use the tracker
Mark an item Done only when it is in place and someone actually does it. Use In progress for habits you are setting up and Not yet for gaps you know about. Items you leave blank are shown as Not checked, never as Done. Mark an item Does not apply only after checking with your payer or state; for example, EVV items may not apply to a private-pay-only agency.
- Mark each item Done, In progress, Not yet or Does not apply.
- Use the source line under each item to check what the payer, your state or the cited agency says.
- Ask your payer, your accountant or counsel about anything marked as their decision.
- Work on the items marked Not yet, starting with the ones that stop you from billing.
- Print the tracker or download a CSV, and repeat the weekly review on your own schedule.
What the tracker does not do
It does not tell you what a payer will pay, whether a claim will be accepted, how long payment takes, or how much money will come in. It does not hold invoice amounts or balances for you. Keep those in your own books; use the note on each item for anything you want to remember.
Where your entries are stored
Your entries are saved only in this browser on this device so you can come back to them. They are never sent to us. Printing and CSV download happen on your device, CSV cells are protected against spreadsheet formulas, and Reset erases only this tracker’s saved entries.
A planning aid, not a promise. Nothing on this site can tell you whether or when a client or payer will pay. It describes billing habits and points you to the rules that apply, so you can check them for your own agency.
Your payers and your state set the details. Each payer’s contract and provider manual, and your state Medicaid agency for Medicaid and EVV, decide what you can bill, how, and with what documentation. This site does not list payer or state rules. Not billing, legal, tax or financial advice. Payer and state rules vary.
Frequently asked questions
Why does the tracker not give me a score?
A score would suggest your billing meets a standard or that payment will follow, and we cannot judge either. The tracker shows counts and lists the items marked Not yet instead.
Can I track invoice amounts here?
Not as a ledger. Keep amounts and balances in your own accounting records. You can use the optional note on an item for a short reminder.
Want to talk through your options?
A free 15-minute clarity call with Home Care Agency Blueprint. It helps people start home care agencies, so expect that perspective. You do not need your billing set up first.
Book a free 15-minute clarity call