Understanding your home care invoice

If you’ve ever tried to read a hospital bill or one from your doctor’s office, you know it can be challenging. All those abbreviations! And since there is no one standard for medical bills, one provider’s bill can look very different from another’s. 

It’s no different when it comes to home care invoices. What’s a CNA? What’s an HHA? What does “Level 1” mean? And, just like hospitals, different home care agencies may use different billing formats. 

Not understanding what your bill is telling you can leave you wondering whether you’re receiving the right care. But no matter what your bill looks like, there are a few things you can do to understand home care invoices. 

Knowing your plan of care is a good idea in any event, but it can be especially helpful when it comes to understanding your bill. When you receive an invoice, compare it to what is in your plan of care. Do things match up? For example, if your plan includes a certain number of hours of homemaker services per week, did the agency provide the correct amount?

Some agencies may include their Care Notes, an itemized list of services per caregiver per shift. This can make it much easier to compare the care you’re getting billed for to your actual plan of care. 

With so many acronyms, the language of healthcare can sometimes seem like alphabet soup. Knowing what your provider’s billing codes mean can clear up a lot of confusion. Some codes may be obvious, such as OT for overtime or CG for caregiver. Other common home care billing codes include: 

1. Code: CNA
   What it means: Certified nurse assistant
   What is provided: Assistance with activities of daily living (ADLs) such as bathing and dressing
   
   

2. Code: HHA
   What it means: Home health aide
   What is provided: Help with ADLs as well as light housekeeping duties and help with medications 
   
   

3. Code: HMK
   What it means: Homemaker services 
   What is provided: Light housekeeping and errands 
   
   

4. Code: LPN
   What it means: Licensed practical nurse
   What is provided: Skilled nursing care such as administering medications and providing wound care
   
   

5. Code: PCA
   What it means: Personal care attendant, assistant, or aide
   What is provided: Non-medical help with ADLs and companionship
   
   

6. Code: POC
   What it means: Plan of care
   What is provided: Refers to the plan you and your provider established before you started receiving services 
   
   

7. Code: RN
   What it means: Registered nurse 
   What is provided: Skilled nursing care; may supervise delivery of care and is typically billed by visit rather than by the hour

A home care invoice may refer to various levels of care provided by aides and may charge a different rate for each level. What is included in each level can vary greatly from provider to provider, but here’s an example:

• Level 0: Homemaker services 

• Level 1: Supervision, or when a caregiver is monitoring an activity such as getting out of bed, standing up from a seated position, or taking a shower to ensure the care recipient’s safety. 

• Level 2: Hands-on assistance with these and similar activities. 

• Level 3: “Mechanical lift,” assistance using a Hoyer lift or other device to help a care recipient with limited mobility transfer between beds, chairs, and wheelchairs, or from sitting to standing. 

Tip: If you would like to see additional detail on the invoices you receive, ask your provider if they can provide an itemized bill. 

Another way to make invoices easier to interpret is to keep a regular log of the care you receive, including your caregiver’s name, hours worked, and what services were provided. When you receive a bill, compare it to your notes. Check the math. Do the numbers add up? Check with your provider or caregiver if you see any discrepancies. For more ideas on keeping a care notebook, check out this blog.

It’s possible your provider showed you a typical invoice and went over it before you started receiving care. If not, they can still be an excellent resource to help you understand your invoices. Ask your caregiver or the office staff to walk you through a bill and answer your questions. Ask for a glossary of the codes, levels of care, and terms they use.  

Understanding a home care invoice may be easier than you think. Knowing your plan of care, tracking your care, and consulting your provider can help you feel confident you’re getting the care you need and being properly billed for it. And that can help you feel good about your aging care experience overall. 

Want to learn more? Download this sample invoice, which has been labeled to help you understand the elements of a typical home care bill.