Who works at a home health agency, and how does a patient reach you?
The short answer
Every Medicare-certified agency has an administrator, who runs the agency day to day, and a clinical manager, who oversees patient care. The other office jobs, like intake, scheduling, QA, coding and billing, go by different titles at different agencies. Before the first visit, the agency confirms the order, checks the insurance and decides whether it can meet the patient's needs. That visit is due within 48 hours of the referral or the patient's return home, unless the doctor or other ordering practitioner sets a date.
When a new patient shows up on your schedule, the agency has already taken the referral, confirmed the order, checked the insurance and assigned the visit.
The two bosses you'll hear about
Two jobs run things at every Medicare-certified agency. The administrator runs the agency day to day. The clinical manager oversees patient care and the people who give it, including who gets assigned to which patient. A patient who wants to talk about their services is pointed to the clinical manager, and one who wants to complain is pointed to the administrator.
You may also hear "director of nursing." In some states that comes from licensing rules, and some agencies use it for the clinical manager.
Fine print
The administrator must "be responsible for all day-to-day operations" and make sure a clinical manager is available during all operating hours. Patients are given the administrator's name, business address and phone number for complaints. The rule calls for "one or more qualified individuals" to "provide oversight of all patient care services and personnel," and that oversight has to include, in the rule's words: "making patient and personnel assignments," "coordinating patient care," "coordinating referrals," "assuring that patient needs are continually assessed" and "assuring the development, implementation, and updates of the individualized plan of care." A clinical manager must be a physician, a registered nurse, a physical therapist, an occupational therapist, a speech-language pathologist, an audiologist or a social worker.
The office behind your schedule
No federal rule defines the rest of the office, and titles vary. Chapter 1 named intake, scheduling, QA, and coding and billing. At many agencies, intake handles the referral, the order and the insurance, and scheduling assigns your visits. QA reads your assessments and notes before they're final, and coding and billing take it from there.
Fine print
Many agencies divide the work further. Intake takes the referral, gathers the paperwork, confirms the order and checks the insurance. Scheduling assigns visits to clinicians. Coding turns the diagnoses in the record into the codes that go on the claim. Billing sends the claim and follows up on denials. A liaison builds and keeps up relationships with the people and places that refer patients.
Who else you'll see on a case
A plan of care can call for more than one discipline, so one patient might have a nurse, a therapist, a social worker and an aide, all working from the same plan. Nursing is supervised by a registered nurse, and rehabilitative therapy by an occupational or physical therapist. A social worker can be ordered when social or emotional problems are expected to get in the way of treating the medical condition.
Fine print
The disciplines are registered nurses and licensed practical nurses, physical therapists and their assistants, occupational therapists and their assistants, speech-language pathologists, medical social workers and home health aides. When an aide works alongside skilled care, a registered nurse or other appropriate skilled professional who knows the patient must complete a supervisory assessment of the aide's services "no less frequently than every 14 days." The social worker rule's words are "social or emotional problems that are expected to be an impediment to the effective treatment" of the medical condition. Social work can be covered only while the patient needs intermittent skilled nursing, physical therapy or speech-language pathology, or has a continuing need for occupational therapy after qualifying through one of those. The rules require the agency to "integrate services" and to "coordinate care delivery to meet the patient's needs."
Where your patients come from
Referrals come from hospitals and skilled nursing facilities, and from the community. Medicare requires an order from a physician or allowed practitioner either way, and no hospital stay. The patient picks the agency, so a hospital hands over a list rather than choosing for them. Not every referral ends in a visit, and a study of hospital referrals found just over half led to a visit within two weeks of discharge.
Fine print
The commission that advises Congress on Medicare (MedPAC) found that in 2021 about half of home health stays under traditional Medicare followed a hospital or skilled nursing facility stay, and about half began in the community. Among formal care settings that follow a hospital stay, home health is the most frequent: it was the first post-acute stop after 18.0% of traditional Medicare discharges from general acute care hospitals in the first ten months of 2024. The hospital rule says the discharge plan must include a list of the Medicare agencies that serve the patient's area and have asked to be listed, for patients who need home health. The hospital "must inform the patient or the patient's representative of their freedom to choose among participating Medicare providers" and "must not specify or otherwise limit the qualified providers or suppliers that are available to the patient." In a study of 2.4 million Medicare hospital discharges with a home health referral, between October 2015 and September 2016, 54.0% were followed by a home health visit within 14 days of discharge.
What intake checks before you get the patient
Intake makes sure there's an order from a physician or allowed practitioner. Chapter 5 covered the rest of eligibility, including the face-to-face visit. Intake also checks who's paying. For traditional Medicare, agencies can look up coverage in real time through a federal system. Most Medicare Advantage enrollees are in plans that require prior authorization for home health. Then the agency decides whether it can meet this patient's needs where they live. The agency reviews its acceptance policy every year and applies it the same way to every referral.
Fine print
CMS's words on the eligibility system are that it lets agencies "check Medicare beneficiary eligibility data in real-time." In 2026, 55% of eligible beneficiaries are in Medicare Advantage plans, and by KFF's count, which leaves out employer group and special needs plans, about 90% of enrollees are in plans that require prior authorization for home health services. The acceptance rule's words are "on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence." The policy has to address, "including, but not limited to," the patient's anticipated needs, the agency's case load and case mix, its staffing levels and the "skills and competencies of the HHA staff." Agencies must also make public "accurate information regarding the services offered by the HHA and any limitations."
The 48 hours
Your agency has 48 hours from the referral, or from the patient's return home, to make the first visit. If the doctor or other ordering practitioner set a start date, the visit happens that day instead. If the clock runs from the referral, the acceptance decision, the insurance check and the scheduling all have to fit inside the 48 hours.
| Step | What happens |
|---|---|
| Referral comes in | The 48 hours can start here, or when the patient returns home |
| Order confirmed | Intake makes sure there's an order from a physician or allowed practitioner |
| Insurance checked | Intake checks who's paying. Inside the 48 hours if the clock runs from the referral |
| Acceptance decision | The agency decides whether it can meet this patient's needs where they live. Inside the 48 hours if the clock runs from the referral |
| Visit scheduled | At many agencies, scheduling assigns your visits. Inside the 48 hours if the clock runs from the referral |
| First visit | Within 48 hours of the referral or the patient's return home. If the doctor or other ordering practitioner set a start date, the visit happens that day instead |
Fine print
The rule's words are that the initial assessment visit must happen "within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner-ordered start of care date."
Who gets told what
For a few situations, the rules name who has to hear about it. Your agency's policies add the detail and the order.
| What happened | Who gets told |
|---|---|
| The patient's condition or needs change in a way that suggests the plan of care should change | The physician or other ordering practitioner, promptly |
| A visit was missed and can't be rescheduled | The physician or other ordering practitioner |
| The patient wants to discuss their services | The clinical manager, whose contact details the patient is given in writing |
| The patient wants to complain | The administrator, whose contact details the patient is given at the initial visit |
Fine print
The contacts in this table come from the rules and from CMS's guidance to surveyors.
What the patient gets from the office
At the first evaluation visit, before any care is given, the patient gets a written notice of their rights and signs to confirm it. They also get written instructions with the visit schedule and the medication schedule, and those include the clinical manager's name and contact information.
Fine print
The first-visit papers also include the agency's transfer and discharge policies and the administrator's contact information. The rule's words are that the instructions include the "name and contact information of the HHA clinical manager."