Free Home Health Care Invoice Template

This template is for home care agencies and independent caregivers who bill clients directly: the client, or the family member or other responsible party who pays for their care. It suits private-pay services such as personal care, companionship, homemaker help, respite and private-duty nursing.

It is an invoice, not an insurance claim form. If you bill Medicare, Medicaid or a health insurer, you use their claim process instead (see "Private pay, Medicare and insurance" below).

An invoice fits when you run the business: an agency, or a self-employed caregiver who controls how the work is done. If a family hires a caregiver directly and controls how the work is done, the caregiver may be their household employee, paid wages rather than invoices. IRS Publication 926 explains the test and lists caretakers, health aides and private nurses among its examples of household workers.

The home care visit invoice has:

• Care provider: your business details, with a "License no." field if your state requires one.
• Invoice details: invoice number, invoice date, service period, payment terms and due date.
• Bill to (responsible party): the person paying, their relationship to the client and their billing address.
• Client receiving care: the client's name, the service address and your service agreement number, kept separate from the payer.
• Visit log: one line per visit or shift with the date, caregiver, service, hours, hourly rate and amount.
• Mileage: trips made for the client, with the date, caregiver, trip, miles, rate per mile and amount.
• Totals: a subtotal for the visits and one for mileage, then the subtotal, total, "Less: advance payment received" and the amount due.
• How to pay: accepted methods, placeholders for your account name and bank details, and the payment reference to quote.
• A footnote saying it is an invoice for private-pay home care, not an insurance claim form, and contains no medical information.

It comes as three files:

• PDF: a blank form to print and fill in by hand.
• Word (.docx) and Excel (.xlsx): the same layout filled with sample values. Overwrite them with your own. In the Excel file, line amounts, subtotals and totals are formulas, and the amount due is the total less the advance payment you type in. If there is no advance payment, set that line to 0.00 rather than deleting the row, because the totals refer to it. In the Word file you can simply delete lines you don't need.

The sample covers one week of visits. Its rates, hours and mileage rate only show how the form works. They are not typical market rates. Use the rates in your own service agreement.

Give each visit or shift its own line, and take the hours from your caregiver visit records or timesheets so the family can check the invoice against them.

• Date of the visit or shift.
• Caregiver by name, so the family can match the line to who was there.
• Service in plain words, for example personal care, companionship, homemaker services, respite care, errands or transportation, or private-duty nursing if you are licensed to provide it.
• Hours × rate = amount. If different services or times carry different rates (weekends, holidays, overnight or live-in care), bill them on separate lines at the rate your agreement sets.

If your agreement has a minimum visit length, bill visits at the minimum and say so in your terms, so a short visit billed at a longer time doesn't look like an error.

Keep housekeeping and other household help on separate lines from personal or nursing-type care. It helps clients who track their costs for tax purposes: in the US, IRS Publication 502 treats nursing-type services and household help differently (see the tax question in the FAQs below).

Describe the service, not the person's health. Write "Personal care, 4 hrs", not a diagnosis, medications or care notes. Clinical details belong in the care record. An invoice gets emailed, forwarded to relatives and filed with household papers, so keep it to what is needed to bill.

Billing cycle. For ongoing care, bill on a regular cycle, for example weekly or every two weeks, and print the service period on each invoice. If you also run payroll for caregivers, a cycle that lines up with your pay periods makes reconciling hours easier.

Due date. Print an actual date as well as the terms (the sample says 14 days and gives the date), so the payer knows when payment is due, and ask them to quote the invoice number when they pay. Billed's guide to invoice payment terms explains the common options.

Advance payments. If you take a deposit or advance payment when care starts, take it off the invoice it applies to on the "Less: advance payment received" line, so the amount due reflects what the family has already paid. Say in the notes when it was paid if that helps the family match it to their records.

Late fees. Charge them only if your service agreement says so and the rules where you work allow it. Check your state or local rules before you set a rate. The late fee calculator can help you work out the amount.

Whether HIPAA applies to your business depends on what you do. CMS says health care providers who submit HIPAA transactions, like claims, electronically are covered. An invoice template can't make a business compliant with any privacy law. Whatever rules apply to you, keep diagnoses, medications and care notes off the invoice, and send it only to the person responsible for paying.