Healthcare Payroll Checklist
Healthcare payroll is uniquely complex. Nurses, doctors, and staff often work variable shifts, earn differential pay, and may even be employed under multiple pay rates. Add compliance requirements for benefits and overtime, and payroll can quickly become overwhelming. This Healthcare Payroll Checklist will help you keep everything organized and compliant. Download the printable PDF version for your HR or payroll team.
Step 1 – Classify Employees & Contractors
- Identify W-2 employees vs. 1099 agency staff.
- Verify exempt vs. non-exempt status under FLSA.
- Maintain contracts and credentialing records.
Step 2 – Track Shift Differentials
- Apply higher pay rates for night shifts, weekends, and holidays.
- Ensure differentials are factored into overtime calculations.
- Record separate pay codes for each shift worked.
Step 3 – Manage Multiple Pay Rates
- Nurses and staff may work at different rates (e.g., RN vs. charge nurse shifts).
- Track roles and pay rates accurately in the payroll system.
- Apply blended overtime rates when employees work across roles.
Step 4 – Handle On-Call & Overtime Pay
- Compensate on-call staff per policy or state law.
- Pay overtime at time-and-a-half beyond 40 hours (or daily in certain states).
- Track compliance with healthcare-specific labor laws.
Step 5 – Verify Benefits & Eligibility
- Track healthcare benefits enrollment (medical, dental, vision).
- Manage retirement plan contributions.
- Ensure compliance with Affordable Care Act (ACA) for full-time staff.
Step 6 – Recordkeeping & Compliance
- Maintain timesheets, schedules, and differential pay logs.
- Retain payroll records for at least 4 years.
- Stay audit-ready for both IRS and healthcare regulators.
Download the Healthcare Payroll Checklist PDF
Get the printable version here: Download Healthcare Payroll Checklist PDF
FAQs
How do you calculate overtime for employees with multiple pay rates?
Use a blended rate calculation based on weighted average across hours worked at each rate.
Are shift differentials mandatory?
Not federally, but many healthcare employers and union contracts require them.
Do on-call hours count as hours worked?
It depends – if employees must remain at a designated location or severely restrict their activities, on-call hours may count as paid time.
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Related Checklists
If you’re handling payroll for multiple states, you may also need our Payroll Tax Compliance Checklist and Payroll Recordkeeping Checklist
