CFO services for home health and care agencies.
An agency's product is a caregiver's hour, delivered somewhere else. Margin is decided by how those hours are scheduled, traveled, classified, and reimbursed — by payer source, by service line, and by branch. We bring finance leadership that manages the hour.
The finance problems that define this segment.
Labor is the cost base and it is variable by the visit.
Caregiver wages, overtime, travel time, mileage, and non-billable hours must be tracked per client and per visit; most agencies see only total payroll.
Margin by payer source is unknown.
Medicare episodic payment, Medicaid waiver hourly rates, private pay, and long-term care insurance reimburse differently and carry different documentation and collection burdens; the blend hides the losers.
Scheduling drives profitability.
Short shifts, split shifts, and travel between distant clients destroy margin; scheduling is treated as an operations task, not a financial one.
Classification and overtime exposure compound.
Contractor caregivers, unpaid travel time, and missed overtime across hundreds of workers create liabilities that surface in audits and diligence.
Authorization and documentation gate revenue.
Missing authorizations, late plan-of-care signatures, and visit documentation failures turn delivered care into unbillable hours.
Cash lags care.
Medicare and Medicaid timing, private-pay collections, and long-term care insurance claims processed by families put days to cash well past payroll cycles.
Branches grow without their own numbers.
New territories opened on referral relationships, with shared costs never allocated and branch profitability never seen.
How we run finance here.
- Visit-level economics — billable hours, wage cost, travel and mileage, overtime, and non-billable time by client, caregiver, and payer source.
- Margin by payer source and service line monthly, with the collection burden and days to cash by source.
- Scheduling finance — margin impact of shift length, travel distance, and caregiver-client matching reported to operations weekly.
- Classification and wage-hour review with counsel; exposure quantified and reserved where warranted.
- Authorization and documentation controls measured: authorized hours vs. delivered, plan-of-care timeliness, unbillable visit rate.
- 13-week cash forecast built from the claims aging by payer source; working-capital facility sized to it.
- Branch profit and loss with allocated costs; new-territory model with referral ramp, staffing, and cash requirement.
- Sponsor or owner pack with utilization and labor metrics first.
Key metrics we build and report.
| Metric | What it tells you |
|---|---|
| Gross margin per billable hour by payer source | Whether each source covers its cost |
| Caregiver utilization (billable / paid hours) | Labor efficiency |
| Overtime and travel as percent of wages | Scheduling quality and exposure |
| Unbillable visit rate and reason | Documentation and authorization control |
| Authorized vs. delivered hours | Revenue at risk |
| Days to cash by payer source | Working-capital need |
| Caregiver turnover and cost per hire | Workforce stability |
| Revenue per client and average length of service | Client economics |
| Branch contribution margin | Which territories earn |
Worked example.
A three-branch non-medical home care and skilled home health agency, $11.2M revenue, 240 caregivers.
The plan: scheduling rules for shift length and travel radius; documentation controls before claim submission; payer-mix targets and a waiver-rate advocacy case; a retention program measured against cost per hire; a 120-day decision point on branch 3.
Where we’ve done this.
Agencies scaling from one branch to regional footprints; operators blending skilled and non-medical lines; hospice organizations; sponsor-backed home care platforms integrating acquisitions. Pattern-level only.
Payroll is our whole cost. What can finance actually change?
How the hours are scheduled, classified, and matched to payer sources — the three levers that decide margin per hour.
Can you quantify our classification exposure?
Yes, with counsel: back wages, overtime, taxes, and benefits over the look-back period, so you can decide with a number in front of you.
Do you handle billing?
No; we own the revenue cycle metrics and the controls that keep delivered care billable, alongside your billing team.
Do you work with sponsor-backed agencies?
Yes: sponsor pack, covenant model, branch and acquisition integration, exit preparation.
Further reading.
Contractor or Employee? The Financial Exposure of Clinician Classification
Why behavioral health practices that classify clinicians as independent contractors carry exposure that compounds quietly — and how to quantify and manage it.
Read article → InsightThe 13-Week Cash Forecast for a Behavioral Health Group
How to build and run a rolling 13-week cash forecast in a behavioral health practice — collections by payer, payroll timing, a worked example, and the decisions it makes possible.
Read article → InsightThe Monthly Management Report for a Behavioral Health Group: What Belongs In It
The metrics, statements, and commentary a behavioral health practice's monthly report should contain, with a sample page-one — and the order that makes it useful to owners and boards.
Read article →Insights for this vertical.
Tell us about the organization.
One conversation about where the numbers stand and what the next stage needs from finance. We will tell you where we can help, where you need someone else, and what it would cost.
The information on this page is provided for general informational purposes and does not constitute accounting, tax, legal, or investment advice. Reimbursement, licensing, and compliance matters in healthcare depend on payer contracts, state rules, and the specific facts of the organization and change frequently. Figures in examples are illustrative. See our full Legal Disclaimer.