Getting paid
Almost every home-health clinician paid per visit has been told they're exempt from overtime. Sometimes that's correct. Sometimes it isn't, and almost nobody checks — because checking requires a record most people don't keep.
This is not legal advice, and it is not a reason to go to war with your agency. Classification is genuinely fact-specific and plenty of agencies get it right. The point of this page is narrower: to show you what the question actually turns on, so you can tell whether yours is worth asking about — and to point out that the answer depends on records only you can keep.
Agencies routinely classify RNs, PTs, OTs and SLPs as exempt learned professionals. To actually hold, that classification has to clear both of these:
Per-visit pay can be a fee basis — a fee basis means an agreed sum for a single job regardless of how long it takes, which describes per-visit pay reasonably well. But it isn't automatic, and it has conditions. If the pay-basis half fails, the exemption fails, however professional the work is.
PTAs, COTAs and OTAs are a different situation. The learned-professional duties test is hard for assistant-level roles to satisfy, and the Department of Labor has taken enforcement action against home-health employers that classified therapy assistants as exempt and paid them per visit.
If you're an assistant being paid per visit and told you're exempt, that is worth a closer look than most people give it.
Here's the piece that surprises people. If you are non-exempt:
In home health that middle category isn't a rounding error. It's the shape of the whole day. Four visits spread across a county can be two hours behind the wheel between doors.
Mileage reimbursement is not wages. This is the single most-confused point in the whole subject. Reimbursement pays you back for what the car cost — fuel, tires, depreciation. Wages pay you for your time. They are different obligations, and an agency paying you 40¢ a mile has not thereby paid you for the hour you spent driving. One does not stand in for the other.
And if you are properly exempt, none of this creates an hourly claim — exempt means hours worked isn't the basis you're paid on. That's the honest version. It's still worth knowing which side of the line you're on, because most clinicians have never been told there was a line.
If you're a genuine independent contractor, overtime and travel-time rules don't apply to you at all — you're running a business, and your drive time is your own cost of doing business (which is exactly why the mileage deduction matters so much more to you).
The catch is that "1099" is a label, not a legal conclusion. Whether you're really a contractor turns on how much control the agency has over how you work — the schedule, the methods, the documentation system, whether you can turn down cases. A worker labelled 1099 who is treated like an employee is a misclassified employee. That's its own conversation, and also not one to have without records.
Notice that every version of this question — exempt or not, employee or contractor, wages or reimbursement — comes down to the same evidence:
Nobody keeps this. That's the real problem. The clinician who suspects something is off usually has a feeling and a stack of pay stubs, and a feeling isn't something anyone can act on — not a preparer, not HR, not an attorney, and honestly not the clinician either.
A contemporaneous record turns "I think I'm getting shorted" into a number. Sometimes the number says everything is fine, which is worth knowing too.
This is the record VisitWell keeps as a side effect of planning your day. Visits get a real timestamp when you mark them done — so first-door-to-last-door is something you can read off, not reconstruct. Drive legs are logged patient to patient, and the exported mileage CSV carries between-patient miles and commute miles in separate columns, because the two are not the same thing under either the tax rules or the wage rules. Per-visit pay is tracked against what you actually completed, so "what I was paid" and "what I did" sit next to each other rather than in two different systems.
None of it leaves your phone, which matters here more than usual: this is exactly the kind of record you want to exist and want to control.
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Sources for the rules described above: the Department of Labor's guidance on travel time for direct care workers and Fact Sheet #79D on hours worked in domestic service employment, and the FLSA regulations on the learned-professional exemption. Salary thresholds change periodically — check the current figure rather than any number quoted in an article. Nothing here is legal advice; an employment lawyer in your state can tell you what your situation actually is, and most will say so in a free first call.