-
Bookkeeping for home care and home health agencies: how LedgerBPO runs it
Bookkeeping for home care & home health agencies means keeping Medicaid waiver claims, private-pay invoices, EVV-verified visit data and weekly caregiver payroll tied together in one clean ledger. LedgerBPO gives your agency a named, HIPAA-trained accountant who works from your AxisCare, WellSky, Alora or HHAeXchange exports inside your own QuickBooks Online file, with a BAA signed before any data moves.
01 / 06 -
What we handle
Bookkeeping for home care & home health agencies means keeping Medicaid waiver claims, private-pay invoices, EVV-verified visit data and weekly caregiver payroll tied together in one clean ledger. LedgerBPO gives your agency a named, HIPAA-trained accountant who works from your AxisCare, WellSky, Alora or HHAeXchange exports inside your own QuickBooks Online file, with a BAA signed before any data moves.
02 / 06 -
Billing and books together
Visits billed from EVV-verified data and posted by payer in your ledger
03 / 06 -
Reconciled every month
Weekly caregiver payroll reconciled to billed hours every pay period
04 / 06 -
What you see
One HIPAA-trained team for claims follow-up and month-end books
05 / 06 -
A named accountant, a backup and a team lead
Inside your own software, on a fixed close calendar, with a reply from a person within 1 business day. Call +1-657-777-0006 or start a quote.
Book a billing audit 06 / 06
· Reviewed by Nimra Khalid
Home care accounting challenges
- 01
Payroll runs weekly, Medicaid pays in weeks
Caregivers are usually paid every week or two, while Medicaid MCOs and waiver programs settle clean claims roughly 30 to 45 days after submission. An agency funds four to six payroll cycles before the first dollar for those visits arrives, so every unbilled visit is a direct cash drain.
- 02
Caregiver turnover near 80 percent
Activated Insights' 2024 Home Care Benchmarking Report put median caregiver turnover at 79.2 percent for 2023. Every departure means a final paycheck, an onboarding cost and a schedule gap that can leave authorized hours unbilled.
- 03
EVV mismatches turn into denials
Section 12006 of the 21st Century Cures Act requires states to reject Medicaid personal-care and home-health claims that lack a matching EVV record. One missed clock-in on a two-hour visit removes eight 15-minute units from the claim unless someone catches it before billing.
- 04
Three payers for one client
A single client can be split across a Medicaid waiver, a long-term-care insurance policy and a private-pay balance, each with its own rate, unit rounding and invoice format. Posting the visit once and allocating it three ways is where most agency ledgers drift away from the scheduling system.
- 05
Overtime and travel time add up quietly
Since the 2015 DOL Home Care Rule, most agency caregivers are covered by FLSA overtime, including time spent traveling between clients on the same day. An agency billing $28 an hour and paying $17 plus time-and-a-half can watch a visit's margin disappear when the schedule stacks hours on a few caregivers.
What we handle for home care and home health agencies
Visit-to-invoice reconciliation
Every billed unit is traced back to an EVV-verified visit in AxisCare, WellSky, Alora or HHAeXchange before it is posted to revenue.
Payer-level revenue and aging
Medicaid, MCO, VA, long-term-care insurance and private pay each get their own revenue account and aging report, so you see who owes what.
Payroll tied to billed hours
We reconcile the Gusto, ADP or Paychex register to scheduled and billed hours each pay period and flag paid time that was never billed.
Claims follow-up under a BAA
HIPAA-trained billing agents work denials, resubmissions and MCO portals under a signed business associate agreement.
Private-pay statements and reminder calls
Weekly or biweekly statements go out under your agency's name, followed by courteous reminder calls through our BillingLine desk.
Month-end close with two reviewers
Bank, card, payroll and claims-clearing accounts are reconciled and checked by a second accountant before your P&L is issued.
Home care software we work in
- QuickBooks Online
- Gusto
- ADP
- Bill.com
- AxisCare
- WellSky
- Alora
- HHAeXchange
- All 50 platforms
Home care compliance notes
EVV
The 21st Century Cures Act requires electronic visit verification for Medicaid personal-care and home-health visits, captured through state aggregators such as HHAeXchange or Sandata. We bill only from verified visits and keep an exception log for visits that need a manual correction before they can be claimed.
HIPAA
Client names, diagnoses and authorizations are protected health information. We sign a BAA, our staff are HIPAA-trained, access is limited to the roles that need it, and PHI never appears in ledger memos or emailed spreadsheets.
State Medicaid and MCO rules
Each state waiver and each managed-care organization sets its own authorization limits, unit rounding, timely-filing window and recoupment process. We track authorizations against billed units and record recoupments as reductions to the original claim, not as unexplained bank debits.
FLSA Home Care Rule
Most agency caregivers are entitled to minimum wage and overtime, and travel time between clients counts. Your payroll provider computes the pay; we make sure the ledger and the labor-cost reports reflect it correctly and that live-in and sleep-time arrangements are coded as your counsel directs.
KPIs we report
| KPI | Why it matters |
|---|---|
| Visits billed within 48 hours of EVV verification | Every day a verified visit sits unbilled pushes Medicaid cash further past the payroll that already paid for it. |
| Unbilled verified visits older than 7 days | This is the earliest warning that authorizations, EVV exceptions or missing notes are blocking revenue. |
| Days sales outstanding by payer | Medicaid, MCOs and private pay behave differently, so a blended number hides the payer that is slipping. |
| Gross margin per billable hour | Caregiver wage, overtime and travel time against the payer rate tells you whether a contract is worth staffing. |
| Payroll as a percent of revenue | A rising ratio usually signals unbilled hours before it signals a wage problem. |
Case study
90+ day AR down 62%
Case studyCutting 90+ day AR by 62% for a home-care agency
A home-care agency in the Midwest billed a mix of Medicaid waiver programs, managed-care plans, long-term care insurance and private-pay families. Claims went out, but nobody owned the follow-up. Denials sat in the clearinghouse, family invoices were sent once and forgotten, and the 90+ day bucket grew every month. The agency engaged LedgerBPO for home-care billing, accounts receivable and AR follow-up calls. A named billing specialist, a backup and a team lead worked inside the agency's scheduling software, clearinghouse and QuickBooks Online. Over the engagement the 90+ day AR balance fell by 62%. The agency did not add staff, change payers or switch software. It added a team whose only job was to bill cleanly and follow every unpaid claim and invoice to a resolution.
Services for home care and home health agencies
- Outsourced bookkeeping for home care & home health agencies
- Invoicing & billing for home care & home health agencies
- Accounts receivable management for home care & home health agencies
- Accounts payable processing for home care & home health agencies
- Bank & credit-card reconciliation for home care & home health agencies
- Month-end close for home care & home health agencies
- Monthly financial reporting for home care & home health agencies
- Catch-up bookkeeping for home care & home health agencies
- Payroll processing support for home care & home health agencies
- Cash application & remittance posting for home care & home health agencies
- Payment processor & marketplace reconciliation for home care & home health agencies
- KPI dashboards for home care & home health agencies
- Remote controller review for home care & home health agencies
- Accounting software setup & migration for home care & home health agencies
Frequently asked questions
What does bookkeeping for a home care agency include?
It includes posting revenue by payer from verified visits, matching Medicaid and MCO remittances to claims, sending private-pay statements, booking caregiver payroll by department and reconciling every bank, card and clearing account each month. Your named accountant also tracks authorizations against billed units and issues a P&L by payer with a short note on what moved.
Can you work inside AxisCare, WellSky, Alora or HHAeXchange?
Yes. We work from the visit, billing and aging exports those platforms produce and post them into your QuickBooks Online or Xero file. Where a platform pushes invoices to the ledger directly, we map the sync once and reconcile the results monthly. We do not replace your scheduling system or ask you to change it.
Do you handle Medicaid and MCO claims as well as the books?
Yes. Our HIPAA-trained billing agents submit claims, work denials and follow up in MCO portals under a signed BAA, and the same team posts the results to the ledger. Having one team on both sides means the open-claims report and the balance sheet agree, which is where most agencies lose visibility.
How do you protect client and caregiver information?
We sign a business associate agreement before any data is shared, staff are HIPAA-trained, and access to your billing platform is role-limited with MFA. Ledger entries carry claim or invoice numbers, never diagnoses or client names, and files are exchanged through your platform or our LedgerDesk portal rather than email attachments.
How do you handle a client with Medicaid, LTC insurance and private pay?
We record the visit once at the scheduled units, then allocate it to each payer at that payer's rate and invoice format. The Medicaid portion is claimed through the aggregator, the LTC portion goes on the insurer's invoice with the required visit notes, and the private-pay balance appears on the family's statement. Each piece is tracked in its own aging.
What does bookkeeping for a home care agency cost?
Pricing depends on volume and scope, so we send a custom quote within 1 business day. For context, US outsourced bookkeeping typically runs $150 to $1,600 per month (indinero, 2026), and agencies that add claims follow-up or private-pay reminder calls sit toward the higher end because of the volume of transactions involved.
Ask an AI assistant to summarize this page
Opens the assistant with a prefilled prompt so you can check our claims against the page yourself.