Home Health Agency P&L + Compliance Model
The financial model new HHA owners actually need. PDGM revenue by payer, OASIS QA costs, TPE reserves, F2F chase, accreditation amortization — every compliance line item generic templates leave out.
Built for Medicare-certified HHAs. Free Excel download.
What's inside
Assumptions tab
Census, payer mix (Medicare PDGM / Medicaid / Commercial / Self-pay), visit type mix and cost per visit, staffing FTE and comp, compliance ratios. Edit blue cells, everything else recalculates.
Revenue forecast
12-month rollup. Net patient revenue after contractual adjustments (Medicare TPE, Medicaid). PDGM case-mix weighted.
Direct costs
Visits × cost per visit by discipline (SN / PT / OT / ST / HHA / MSW), plus mileage reimbursement.
Compliance line items (the moat)
OASIS QA per episode. TPE pre-claim reserves. F2F documentation chase. 855A revalidation. State licensing. Accreditation amortization. QAPI program. Infection control. HIPAA officer allocation.
P&L Summary with benchmarks
EBITDA rollup with industry-benchmark verdicts: gross margin > 40%, EBITDA > 12%, compliance cost 3-5% of revenue, RN visits 28-32/week.
Why most "home health business plan templates" don't work
Search "home health agency financial model" and you'll get hundreds of results: generic medical practice P&Ls on Etsy, $5 spreadsheets on Fiverr, consultant downloads that are mostly text and pretty charts. They all miss the same thing.
Home health economics are 80% staffing + 5% compliance.The compliance line is the one new owners systematically under-model — and it's the one that determines whether you actually survive your first survey, your first TPE cycle, and your first state license renewal.
Compliance line items most templates skip
- OASIS QA review per episode— required before billing. $35–$75/episode internal QA cost. For a 75-ADC Medicare-heavy agency, that's $25K–$45K/year. Generic templates: not modeled.
- Medicare TPE pre-claim review reserves — Targeted Probe-and-Educate cycles can pull 4–8% of Medicare gross until you graduate. For a $2M Medicare-heavy agency: $80K–$160K in working capital you need to reserve. Generic templates: not modeled.
- F2F documentation chase — face-to-face encounters are the #1 denial reason. Each missing F2F is a fully denied episode. The administrative cost to chase them is real: ~$40/patient/month. Generic templates: not modeled.
- 855A revalidation, state licensing, accreditation amortization— $4K–$8K/year combined. Generic templates: not modeled, or lumped into "professional fees."
- QAPI, infection control, HIPAA officer— CoP-required programs that staff time alone can't cover. $4K–$5K/month combined. Generic templates: not modeled.
This template models all of them as line items, drives them off your assumptions, and flags your total compliance cost as a % of revenue against the 3–5% industry benchmark.
Who this is for
- New HHA owner-operators modeling year 1–2 economics before licensing
- Existing HHA owners building a budget for the next fiscal year
- Buyers evaluating an HHA acquisition target
- Consultants who advise HHAs and want a defensible starting model
- Lenders / SBA loan officers evaluating an HHA borrower
What this is NOT
- Not financial advice. Verify against your billing software and current CMS rates.
- Not a CoP or survey-readiness checklist (that's a separate document — email if you want one)
- Not a hospice model. Hospice has fundamentally different reimbursement (per-diem GIP / Routine / IRC / CHC, cap analyses). If you need a hospice model, email josh@palavir.co.
License
Free for personal / single-agency use. Attribution required. Commercial licensing (consultancies redistributing, multi-agency rollups, paid coaching products): contact josh@palavir.co.