Home Care 101: Rounding Home Care Visits for Billing and Payroll

In the era of Electronic Visit Verification (EVV) we get accurate times of arrival and departure for our home care visits. Whether the caregiver clocks in and out with voice telephony, on a mobile app, or using some other time tracking device like a FOB you end up with a time of arrival and a time of departure that hardly ever match the scheduled time, and often it’s for good reasons…

Let’s take the example of a visit scheduled from 9:00 AM to 12:30 PM. A conscientious caregiver is likely to show up a couple of minutes early, such as at 8:57 AM and to not rush out the door at the end of the shift like a clock watcher, so perhaps they leave at 12:35 PM. Now you have a visit that was scheduled for 3 hours and 30 minutes, but you have clock-in and clock-out times saying that they were there for 3 hours and 38 minutes. What do you do?

How Do You Round Your Completed Shifts?

First and foremost, you shouldn’t be rounding anything yourself. What you should be doing is telling your software vendor how to configure the rounding for you. What the rules are will depend on who your payers are and what your policy is.

Here are some key guidelines and considerations:

• Most payers expect their visits to be rounded to the nearest 15 minutes.
• Most home care agencies round by the duration of the visit. Using the example above where the caregiver clocked-in at 8:57 AM and clocked-out at 12:35 PM, it’s most typical to look at the time between the start and end time and then round. In this case it was 3 hours and 38 minutes. Some agencies individually round the clock-in time to the nearest 15 minutes and the clock-out time to the nearest 15 minutes. This can be problematic. Let’s take a clock-in at 8:52 AM and a clock-out at 12:23 PM. In this case the duration is 3 hours and 31 minutes, but the arrival would round down to 8:45 AM and the departure would round up to 12:30 PM making it look like a 3 hour and 45-minute visit. This would be hard to defend in an audit.
• Some Medicaid payers (like in the Missouri EMOMED program) only pay for completed 15 minute units of care, so if your caregiver works for 59 minutes, you can only bill for 45 (but they let you accrue the additional 14 minutes – if you’re in Missouri and need help with this, let us know. 
• Some payers won’t let you bill more than the scheduled time. If that’s the case, then make sure that your software can clip the billing based on the schedule.
• Similarly, pretty much all Medicaid payers won’t let you bill above what was authorized. So in this case make sure that your home care software is keeping track of the authorized units and not letting you bill above the authorization. Your software should also give you dashboards to see how you are performing against your authorizations (and make adjustments to schedules where the care is running ahead or behind)
• Payroll is a totally different story and we predominantly see two schools of thought. One camp pays their caregivers for what they’re able to bill. Others pay their caregivers for the exact number of minutes that they worked. This latter approach is often mandated by local work councils, so before proceeding with any rounding of payroll, make sure that you’re in compliance with what your labor boards expect.

Do You Have Rounding Challenges?

I’d imagine that a good number of the readers of this article simply round billing and payroll to the nearest 15 minutes, but if you’ve read this far, perhaps you have some tricky challenges such as needing different rounding rules for different payers, or struggling with nursing visits that bill as “one visit” regardless of the time worked. If you need help getting this right, we’d love to hear from you and help.