Three versions of the same month #
Every care service keeps three accounts of what happened in a month, whether or not it thinks of them that way:
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The rota
What was planned. Changed by coordinators, constantly, including at six in the morning.
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The visit record
What was delivered. Changed by carers, from the doorstep, and by the office when something failed to log.
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The invoice
What is being charged. Changed by finance, once, at month end, from whichever of the first two it trusts.
Nothing forces those three to agree. When they disagree, somebody reconciles them by hand, which is why month end in a care office looks the way it does. In the Homecare Association's August 2024 report on CQC regulation, one provider summed the general condition up in three words: "Sheer duplication of work."
What makes council billing its own job #
Private clients are billed on terms the service sets. Contracting authorities are billed on terms the authority sets, and each one sets them differently:
- Its own file format or portal.
- Its own treatment of the difference between planned and delivered time.
- Its own rounding.
- Its own query process.
- Its own remittance timetable.
A service holding contracts with four authorities is running four billing processes in parallel, plus the private one, on the same underlying visit data.
Where the double keying actually happens #
- A cover change entered on the rota at short notice and not in the visit record.
- A visit logged late or not at all, so it exists in the rota and nowhere else.
- A cancelled visit that was still charged, or a delivered visit that was not.
- A rate that changed part way through a period and was applied from the wrong date.
- A query from an authority answered from a spreadsheet nobody else can see.
- A credit note that fixes an invoice but never reaches the visit record it came from.
In the Florence survey of 222 NHS and social care managers published on 4 October 2023, rota scheduling was named as the biggest single consumer of admin time at 43 per cent. The billing consequence of all that rota churn is rarely counted separately, but it is the same churn arriving a month later with a finance label on it.
Which parts run on rules, and which do not #
Reconciliation is almost the definition of rule based work, because every check is a comparison between two records you already hold.
Runs on rules
- A delivered visit with no invoice line against it
- An invoice line with no delivered visit behind it
- A charged rate that does not match the rate on the contract for that date
- A planned visit that was neither delivered nor cancelled, which is a records problem before it is a billing one
- An invoice past its terms with no payment or remittance recorded
- A credit note raised with no corresponding correction in the visit record
Needs the service to decide
- Whether to charge for a visit that was refused at the door
- Whether to write something off for a family in difficulty
- How to handle a disputed period with an authority you want to keep working with
- Whether a pattern of short visits is a billing issue or a staffing one
Those are judgements with relationships attached, and they should be made by somebody who can be argued with.
Regulation 17 asks providers to securely maintain accurate, complete and detailed records for each person using the service. A month where the billing and the visit record disagree is a records failure that happens to have a financial symptom, and it is worth seeing it that way round.
The upstream half of this is last minute cover, which is where most of the discrepancies are created. If unpaid invoices are the sharper end for you, the chasing payment calculator puts your own figures on the chase.