Home care billing: questions, answered
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Short answers to the billing questions new home care owners ask. Where the answer depends on your payer, your state or needs a professional, we say so.
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.
Questions and answers
When can I first invoice a private-pay client?
When your agreement says you will, after the services it covers. Put the invoicing schedule in the service agreement before services start.
Do I need a clearinghouse?
Not necessarily. It depends on how each payer accepts claims; ask the payer. If HIPAA applies to you, decide with counsel whether a clearinghouse or billing company needs a business associate agreement.
What is EVV?
Electronic visit verification: an electronic record that a visit happened, including the service, the client, the caregiver, the date, the location and the start and end times. For Medicaid personal care, your state Medicaid program sets the method.
Can I charge late fees?
Possibly, if your agreement says so and your state’s law allows it. Ask counsel first.
How is Medicaid billing different from private-pay?
Medicaid needs enrollment first, often authorizations, documentation and EVV your state sets, and claims built the way the state program or its plans require. Private-pay follows your own agreement.
Do I need special software?
We do not recommend vendors. What you need depends on your payers and your state’s EVV method; check with them before you buy anything.
Does HIPAA apply to my billing?
It depends. HHS says a provider is a covered entity only if it transmits health information electronically in connection with a transaction for which HHS has adopted a standard, such as a claim. Decide with counsel.
What about Medicare home health billing?
Skilled, Medicare-certified home health has separate federal billing rules. See starthomehealthagency.com, also published by Home Care Agency Blueprint.
How much cash should I keep while I wait to be paid?
That depends on your payroll, your payers and your clients. homecarestartupcost.com, also published by Home Care Agency Blueprint, covers planning startup cash.
Who publishes this site?
Home Care Agency Blueprint, which sells courses and coaching to people starting home care agencies. We say so on every page so you can weigh our perspective.
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