A home health caseload is a list of patients, but you do not manage it as a list. You manage it as a set of clocks. Each patient has a start of care date that sets a 60-day certification period, an order that says how many visits a week, and, depending on your discipline, a reassessment or supervisory visit that has to land by a certain day. Miss one of those clocks and the visit you made may not count.
This guide is for the clinician in the car: the PT, OT, SLP, RN, LPN, PTA or COTA who plans their own visits. It covers the clocks, what to keep on every patient so you are never digging for it, and a routine for the week and the day that keeps everything on time.
A note on who is writing. I'm an occupational therapist and the founder of Logicly, a home health scheduling app for clinicians. The routine here works on paper as well as in any app; where Logicly does a step for you, I say so.
The Short Answer
- Track clocks, not just names. Every patient carries a cert period, a frequency and, for many, a 30-day therapy visit or a 14-day aide supervisory visit.
- Keep one record per patient with the dates, the address and how to get in, the times they can't be seen, and the precautions.
- Plan the week once, before it starts: what is due first, then the fixed visits, then the rest, then each day in driving order.
- Check the day twice: in the morning before you leave, and at the end of the day for tomorrow.
- Treat every change as a scheduling event. A cancellation, a hospital stay or a new referral moves the clocks, not only the calendar.
The Six Clocks Every Caseload Runs On
These come from Medicare's rules for home health. Your agency may add its own, and other payers may differ, but these are the floor.
| Clock | When it runs | Who it applies to | Source |
|---|---|---|---|
| Initial assessment visit | Within 48 hours of referral, within 48 hours of the patient's return home, or on the ordered start of care date | The RN, or the PT or SLP in a therapy-only case | 42 CFR 484.55(a)(1) |
| Comprehensive assessment | No later than 5 calendar days after the start of care | The clinician who opens the case | 42 CFR 484.55(b)(1) |
| Recertification | The last 5 days of every 60-day period, counted from the start of care | The clinician who does the recert | 42 CFR 484.55(d)(1) |
| Resumption of care | Within 48 hours of the patient's return home from an inpatient stay of 24 hours or more | The RN or therapist | 42 CFR 484.55(d)(2) |
| Therapy reassessment | At least every 30 calendar days, by a qualified therapist instead of an assistant, for each discipline | PT, OT, SLP (when a PTA or COTA treats in between) | 42 CFR 409.44(c)(2)(i)(B) |
| Aide supervisory visit | No less often than every 14 days when the patient also gets skilled services | The RN or another skilled professional who knows the patient | 42 CFR 484.80(h)(1) |
Two of these trip field clinicians more than the others. The recert window is only five days wide: for a cert period that ends on a Saturday, the recert visit has to land between Tuesday and Saturday of that week. The 30-day therapy clock resets each time the therapist sees the patient, so in a case where the PTA or COTA does most of the visits, the therapist's own visit has to be planned on purpose. For the full rules, see the 30-day therapy reassessment rule and tracking 60-day certification periods.
Tip
Write the next deadline, not the rule. "Recert window opens Tue 11/17" is something you can act on in the car. "Recert in last 5 days of the period" is something you have to work out again every time.
What to Keep on Every Patient
Most of the time lost in a caseload goes to looking things up: whose patient this is, when the recert window opens, which day is dialysis. Put the answers in one place per patient.
- The agency, if you work for more than one, with the office phone. It tells you which system to chart in.
- Address, phone and how to get in: the door code, the side door, where to park.
- The start of care and the current cert period, with the recert window worked out.
- The frequency as ordered, such as 2w4 then 1w4, and the week it ends. If a frequency is new to you, our frequency guide reads each one.
- The times the patient can't be seen: dialysis mornings, a standing appointment, the hour the caregiver leaves.
- Precautions you need before you knock: oxygen in use, infection precautions, pets, smoking, falls at home.
- For therapy, the date of the last visit by the therapist, so the 30-day visit is never a surprise.
- Your own to-dos for that patient: call the doctor's office about the order, bring the reacher, ask about the hospital follow-up.
In Logicly, this is the patient record: the agency, phone and address on top, the cert periods and recert window worked out from the start of care, the frequency, the blocked times, the precautions and the patient's to-dos. You can enter patients one at a time or upload your caseload from a spreadsheet.
The Weekly Routine
Plan the week once, before it starts. Friday afternoon or Sunday evening both work; what matters is that the orders for the week are in.
- List what is due. Recert windows that open this week, therapy visits that must land before a 30-day clock runs out, frequencies that end, discharges you expect. These go on the calendar first, because they have the least room to move.
- Place the fixed visits. A patient who can only be seen after 2 pm, a visit that has to follow a doctor's appointment, a joint visit with a PTA. Check each patient's blocked times before you choose a day.
- Spread the rest. A 2w4 patient needs two visits this week. Put them a day or two apart, not Monday and Tuesday, so the visits do the patient some good and a cancellation does not leave you short.
- Put each day in driving order. Group patients by area, then order the day so you are not crossing town twice. Our route planning guide covers how.
- Leave room. One open slot most days absorbs a cancellation or a new start of care without moving everything else.
Our step-by-step guide to planning a week of home health visits works one example from orders to a finished week.
In Logicly, the visits a week still needs wait in the visit pool, and Auto-schedule week places them across your working days, a day or two apart for each patient, with each day in driving order. Undo puts the week back if you would rather do it yourself.
The Daily Routine
- Before you leave: check the day's order and the first address, and look at the precautions for each patient. Call ahead where your agency expects it.
- After each visit: mark it done. If a visit did not happen, record it as missed and tell the agency the same day; our missed-visit guide covers what the rules ask for.
- End of the day: look at tomorrow. Is a recert window opening? Did a cancellation leave a patient short for the week? Move it now, while you still have options.
When the Week Changes
- A patient cancels. Do not drop the visit; move it. If the week is full, the visit still counts against the frequency, so the patient may need a missed visit note and the agency needs to know.
- A patient goes into the hospital. The schedule stops, and a resumption of care clock starts when they come home: 48 hours from the return home after a stay of 24 hours or more. See what happens when a patient is back in the hospital and the resumption of care guide.
- A new referral comes in mid-week. The initial visit is due within 48 hours of the referral or on the ordered start of care date. Find the slot first, then move routine visits around it, not the other way round.
Paper, Spreadsheet, Calendar or App
Any of them can work if it shows you what is due without you having to work it out. Here is how they compare for a field caseload.
| Paper planner | Spreadsheet | Phone calendar | Home health scheduling app | |
|---|---|---|---|---|
| Works out cert periods and recert windows | No | Only if you build the formulas | No | Yes, in the ones built for home health |
| Knows each patient's frequency | No | As text | No | Yes |
| Puts a day in driving order | No | No | No | Some do |
| Goes with you to the patient's door | Yes | Awkward on a phone | Yes | Yes |
| Protects patient information if the phone is lost | No | Rarely | Depends on the account | Look for a signed BAA and a lock |
Two cautions. A personal phone calendar or a notes app is easy, but it holds patient names and addresses, which is protected health information, often with no agreement behind it. And a tool that does not know home health will happily let you put two visits for the same patient on back-to-back days or let a recert window pass.
We compare the apps clinicians use, including ours, in the best home health apps for clinicians. Logicly is a home health scheduling app for the clinician who plans their own visits: it runs on your phone and your computer, works out the cert periods, places the week and puts each day in driving order. You can try it on sample patients without signing up.
Keep every clock in one place
Logicly works out each patient's cert periods and recert window from the start of care, places the week's visits from their frequencies and puts each day in driving order.
Key Takeaways
- A caseload runs on clocks: the initial visit, the 5-day comprehensive assessment, the recert window, resumption of care, the 30-day therapy visit and the 14-day aide supervisory visit.
- Keep one record per patient with the dates, the address and access notes, the blocked times and the precautions.
- Plan the week once: what is due, then fixed visits, then the rest, then driving order, then a spare slot.
- Check the day in the morning and look at tomorrow at night.
- A cancellation, a hospital stay or a new referral is a change to the clocks, not only the calendar.
Frequently asked questions
How many patients is a normal home health caseload?
There is no federal number. Medicare sets no caseload size for clinicians; it sets the clocks each patient runs on. Caseloads are set by the agency and by productivity targets, and they vary with the discipline, the length of each visit and how far apart patients live. Judge a caseload by whether every patient's frequency, reassessment and recert dates can be met in your working week, not by the count.
What dates do I need to track for each home health patient?
The start of care date, which sets every 60-day certification period; the recertification window, the last 5 days of each period; the frequency and the week it ends; for therapy, the date of the last visit by the therapist, because a qualified therapist has to see the patient at least every 30 calendar days; for aide cases, the 14-day supervisory visit; and any return home from a hospital stay, which starts a resumption of care clock.
When should I plan my home health week?
Before the week starts, once the orders for the week are known. Many field clinicians plan on Friday afternoon or Sunday evening. Check what is due first (recerts, 30-day therapy visits, frequencies ending), place the visits that have a fixed day or time, then fill the rest and put each day in driving order.
Is a spreadsheet good enough to manage a caseload?
It can work for a small caseload you update every day. Its weak points are the dates: a spreadsheet does not tell you that a recert window opened or that a therapy reassessment is due, it does not know about a visit you moved on your phone, and it is easy to carry patient information on a personal device with no protection. Whatever you use, it has to show you what is due without you working it out.
Sources
- 42 CFR 484.55 (opens in a new tab): (a)(1) initial assessment visit; (b)(1) comprehensive assessment within 5 calendar days; (d)(1) recertification in the last 5 days of every 60 days; (d)(2) resumption of care within 48 hours of return home.
- 42 CFR 409.44(c)(2)(i) (opens in a new tab): initial assessment and reassessment at least every 30 calendar days by a qualified therapist.
- 42 CFR 484.80(h) (opens in a new tab): aide supervisory assessment no less frequently than every 14 days for patients receiving skilled services.
- Related on this site: the 30-day therapy reassessment rule, tracking 60-day certification periods, supervisory visit requirements, the 48-hour rule for referrals.