Home Health Agency Accounting & Bookkeeping
Fairlight Accounting handles the books, payroll, and tax for home health agencies — episodic-payment businesses whose costs walk out the door in cars every morning. We keep episode revenue, visit costs, and field payroll reconciled to what the agency actually delivered.
✓ Books closed by the 15th ✓ Fixed monthly fees ✓ cross-border tax team
The numbers problems home health agencies actually have
Episodic payment vs. visit-level cost
PDGM pays per 30-day period while costs accrue per visit and per mile. Margin per episode requires the two meeting in one ledger — most agency books never manage it.
Field payroll is the cost structure
Per-visit rates, hourly time, mileage, and overtime across clinicians in motion — payroll accuracy is agency profitability, full stop.
Claim timing whipsaws cash
Period billing, NOAs, and final claims create cash rhythms that punish agencies running on bank-balance instinct.
LUPA thresholds turn visits into cliffs
Falling below visit thresholds collapses an episode's payment; near-threshold episodes need flagging while scheduling can still respond.
What Fairlight takes off your plate
The core engagement is the same discipline we run for every client — monthly close by the 15th, payroll, tax, and CFO-level reporting — built around how home health agencies actually make and spend money.
- Episode-level revenue tracking with visit-cost matching
- Field payroll: per-visit, hourly, and mileage — processed and reconciled
- Cash forecasting around claim and NOA timing
- Monthly close by the 15th with margin per episode and per discipline
- Business tax prep, quarterly estimates, and CFO reporting for census growth
The three numbers we keep in front of you
No fabricated benchmarks — your own numbers, measured the same way every month, so trends are real and decisions have a floor under them.
Margin per episode
period payment against the visits and miles it took
Cost per visit by discipline
RN, PT, aide — the building blocks of episode margin
Census and admissions trend
the volume engine, tracked against staffing capacity
Revenue cycle & tax notes
Revenue & reconciliation
We reconcile period payments and final-claim settlements to episode records, keep managed-care and Medicare lanes separate, and work with your billing team so cash timing is planned rather than survived.
Tax & entity
Mileage policies, per-visit contractor versus W-2 classification, and multi-county payroll all carry compliance and cost implications we set up correctly from the start.
Simple, published pricing
Bookkeeping from $310/mo · All-In-One (books + tax + advisory) from $1,955/mo. Every fee is quoted and fixed in writing before any work begins.
Home Health accounting FAQs
Our cash swings wildly — is that fixable?
The swings are structural (claim timing), but they're plannable: a forecast built on your episode pipeline and billing rhythm turns the whipsaw into a schedule.
W-2 or 1099 for field clinicians?
Classification has real tests and real penalties; we walk the factors with you and set payroll up to match the model you can defend — many agencies end up W-2 with per-visit pay structures.
What does it cost?
Bookkeeping from $310/month; All-In-One (books + tax + advisory) from $1,955/month. Exact fee fixed in writing after a short call.
Related healthcare specialties
Get the financial side handled
A free 15-minute call — bring your current setup, leave knowing exactly what clean, specialty-aware books look like for home health agencies.
The content on this page is for informational purposes only and does not constitute professional tax advice. Accounting and tax considerations for healthcare practices depend on individual facts and circumstances and are subject to change. See our full legal disclaimer.