Common home care billing mistakes
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Most billing problems come from gaps in the routine rather than from one big error. Here are mistakes worth checking for, each with its source, a pointer to your payer or state, or marked as our own planning.
Mistakes to check for
Billing before documentation is complete
An invoice or claim with no complete visit record behind it is hard to defend. Record the visit first, then bill it.
Your own planning
No authorization on file
For payers that use authorizations, serving without a current one can leave the visit unpaid. Check the authorization before the first visit and before it ends.
Check your payer contract or provider manual
Wrong payer or client details
A claim with the wrong client identity, payer or identifier can be returned or denied. Check the details against the client’s coverage before you bill.
Check your payer contract or provider manual
Never following up
An invoice or claim nobody follows up on can sit unpaid. Set your own checkpoints and keep to them.
Your own planning
Mixing private-pay and payer balances
When private-pay and payer amounts share one ledger, a client can be billed twice or not at all. Keep a clear ledger for each.
Your own planning
No written payment terms
Without terms in the service agreement, a late payment is harder to discuss. Put the terms in writing before services start, and have counsel review them.
Your own planning
Ignoring denial reasons
A denial or returned claim comes with a reason from the payer. Read it, fix the cause, and resubmit the way the payer allows.
Check your payer contract or provider manual
EVV gaps that block claims
Where your state Medicaid program requires EVV, a visit with missing or mismatched EVV data may not be paid. Check your state’s rules and fix gaps quickly.
Source: Medicaid.gov, Electronic Visit Verification; Check your state Medicaid agency
Using a billing vendor without a written agreement
HHS lists billing and claims processing done on behalf of a covered entity as examples of business associate activities when they involve protected health information. If HIPAA applies to you, a business associate agreement comes first. Decide with counsel.
Source: HHS OCR, Business associates
The owner not reviewing receivables weekly
Open balances that nobody looks at grow quietly. A short weekly review keeps them visible.
Your own planning
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.
What to do next
Frequently asked questions
What is the most common billing mistake?
We do not have data on that, so we will not guess. The mistakes listed here are worth checking first because each can be fixed with a clear routine.
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.
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