Working for Three Agencies: Tracking Pay, Mileage, and Recerts Without Losing Money

Most home health clinicians I've talked to don't work for one agency. They work for two or three, sometimes four during a slow season, and the arrangement is genuinely good — you fill your own week, you turn down what doesn't fit, you're not driving the whole county for one scheduler.

The cost is bookkeeping. Each agency has its own rate card, its own pay period, its own idea of what mileage it reimburses, and its own portal you have to log into to find out whether they paid you what they said they would. Nobody sends you a reconciliation. If a visit falls off a remittance, you find out by noticing.

Here's a system that catches it.

Know what each visit is worth before you drive to it

Per-visit pay means every visit type has a price, and the prices differ by agency. A typical structure:

• Start of care / evaluation — the highest rate, because it's the longest visit and the most documentation
• Routine visit — the bulk of your week
• Reassessment — sometimes the same as routine, sometimes a premium
• Recertification — usually a premium
• Discharge — sometimes paid, sometimes bundled
• Missed visit — occasionally paid at a reduced rate if you drove and the patient wasn't home; frequently not paid at all

The first thing worth doing is writing all of it down in one place, per agency, including the rates you had to ask about. Two clinicians can drive the same route for the same disciplines and earn materially different amounts because one of them knows that Agency B pays a premium for recerts and schedules accordingly.

Ask about, and write down, the answers to these:

• What's the rate for each visit type?
• Is there a mileage reimbursement, and at what rate — or is it built into the visit rate?
• Is there a rate difference for weekends, holidays, or same-day add-ons?
• What happens when the patient isn't home?
• When does the pay period close, and when does payment land?

The reconciliation habit

The thing that actually protects your income is a weekly five-minute habit: after your last visit of the week, log what you delivered per agency.

Date, patient initials, visit type, agency, and miles. That's it. Five fields, and you can do it in a parking lot.

Then, when a pay period closes, you compare your log to their remittance before you cash anything. You are looking for three specific problems:

The dropped visit. A visit you delivered that doesn't appear. Usually a documentation sync issue, and usually fixable if you raise it inside the same pay period. Raise it three months later and you're asking someone to reopen closed books.

The wrong visit type. A recert paid as a routine. This is the most common and the least noticed, because the total looks roughly right.

The missing mileage. Reimbursable miles that didn't get reimbursed, often because the trip wasn't logged in their system even though you drove it.

None of these are anyone acting badly. They're what happens when visit data passes through a documentation system, a billing system, and a payroll system, each with its own idea of what a visit is. But nobody is checking on your behalf.

Mileage: reimbursed, deducted, and the trap in between

Two different things get called mileage, and mixing them up is the most expensive mistake in this category.

Reimbursed mileage is money an agency pays you for driving. It's income-neutral — they're covering a cost.

Deducted mileage is a business expense you claim on your taxes using the IRS standard mileage rate for the year.

The rule that catches people: you cannot deduct miles you were reimbursed for. If Agency A pays you $0.50 a mile and you also claim those same miles as a deduction, that's double-dipping. What you can do, if the reimbursement is lower than the IRS rate and the arrangement isn't structured as an accountable plan, is potentially treat the difference appropriately — and that's a conversation with a tax professional, not a blog post, because how reimbursements are reported changes the answer.

What's worth knowing regardless:

• Commute is not deductible. Home to your first patient and last patient back home is generally commuting. Patient to patient is business mileage. A qualifying home office can change this, which is exactly why it's worth asking someone who knows your situation.
• Miles for one agency aren't miles for another. If Agency A reimburses and Agency B doesn't, you need to know which trips belong to which — which means logging the agency alongside the miles, not just the total.
• Contemporaneous records win. A log kept as you drive is worth far more than a reconstruction in April. Date, start and end, purpose, and mileage.

Run your annual number once and you'll take this seriously: twenty visits a week at fifteen miles each, forty-eight weeks a year, is over fourteen thousand miles. At the IRS rate that's a five-figure line. The mileage reimbursement calculator does that math with the commute rule built in.

Keeping recerts straight across agencies

Every agency's episodes run on their own clock, and the recert window is narrow — the last five days of the cert period. Two agencies, twenty patients, and twenty different cert end dates is where things quietly go wrong.

Two habits help:

Calculate the recert date when you open the episode, not when it's close. Cert end minus five days, written down immediately.

Schedule the recert before the routine visits around it. Routine visits are movable. The recert isn't. Placing it first means you're never trying to squeeze a required visit into a week you've already filled.

The same logic applies to the 30-day therapy reassessment, which runs on days rather than visits and therefore drifts out of sync with your visit rhythm.

What this looks like when it's working

A clinician with three agencies and a working system can answer these questions in under a minute:

• What did I deliver this week, per agency?
• What is each agency going to pay me for this period?
• Which patients are behind on their frequency order?
• Which recerts and reassessments are due in the next two weeks?
• How many unreimbursed miles have I driven this year?

If any of those takes you longer than a minute today, that's not a discipline problem. It's a records problem — the data exists, it's just scattered across three portals, a notebook, and your memory.

A starting point

You don't need software to start. You need one place where the visit, the agency, the visit type, and the miles live together, recorded the day it happened.

The patient roster template gives you the patient side — agency, SOC date, cert period, frequency order — and the PRN and missed-visit tracker covers the other half, where the money leaks: PRN usage against the order, and every missed visit with its reason and make-up date.

Casedaisy does this from the schedule side: each agency gets a rate card, every completed visit inherits the rate for its type, mileage is split by agency according to that agency's policy and the commute rule, and each pay period produces a per-agency total you can check against the remittance — plus a short-paid flag when the two don't match. You still do the five-minute weekly habit; you just don't do the arithmetic.