Home health glossary.

A HIPAA contract.

A required HIPAA contract between a covered entity (an agency or clinician) and any third party that handles protected health information on their behalf. If you are working for an agency, the agency has BAAs with the vendors that touch patient data. If you are 1099 with multiple agencies, each one will want its own.

Infection-control discipline for your nursing bag.

A specific method of using and storing your nursing bag so it does not become a vehicle for cross-contamination between homes. The bag has a clean zone (inside) and a dirty zone (outside the patient barrier), and supplies move in and out under defined rules. Not optional in home health.

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The federal rulebook every Medicare home-health agency must follow.

The Conditions of Participation are the federal rules at 42 CFR Part 484 that an agency must comply with to participate in Medicare. They cover the full operation of a home-health agency, including 484.55 (the comprehensive assessment), 484.60 (the plan of care and care coordination), and 484.110 (clinical records). State surveyors and accrediting bodies check agencies against the CoPs, and findings can affect an agency's ability to bill Medicare. As a clinician, your documentation is what makes CoP compliance visible — the assessment, the plan of care, and the clinical record are all you.

Formal end of the home-health episode.

When the patient has met their goals, refused further care, transferred to a higher level of care, or no longer qualifies (e.g., no longer homebound), the episode is formally closed with a discharge OASIS. Discharge is a clinical decision documented in the chart — not just "we stopped showing up."

The 60-day certification period — billed in two 30-day pieces.

Under Medicare, the home-health certification period is 60 days, opened by a Start of Care OASIS and closed by either a discharge or a recertification into the next 60 days. Since PDGM took effect on January 1, 2020, that 60-day cert is paid in two 30-day periods of care, each with its own case-mix calculation. Most clinicians and agencies still use "episode" to mean the 60-day cert; payment language uses "30-day period." Both terms are in active use, and they refer to different things.

A required physician visit that anchors Medicare home-health eligibility.

For a Medicare home-health admission, the certifying practitioner (physician, or in many cases a nurse practitioner, physician assistant, or clinical nurse specialist) must have an encounter with the patient within 90 days before the Start of Care or within 30 days after it. The encounter must relate to the primary reason home health is needed, and the certifying practitioner must document it. Missing or weak face-to-face documentation is one of the most common reasons a claim gets denied on review, even when the clinical care was solid.

Same acronym, two meanings — context matters.

In a clinical sentence ("the HHA visits Mon/Wed/Fri"), HHA usually means home health aide — the paraprofessional who provides personal care under a nurse's supervision. In a business sentence ("the HHA contracted with us"), HHA usually means home health agency. Disambiguate when it isn't clear.

The patient experience survey behind agency star ratings.

The Home Health Consumer Assessment of Healthcare Providers and Systems is a standardized survey sent to a sample of an agency's patients after discharge. CMS uses the results to calculate the patient-survey star rating on Care Compare and feeds them into the broader quality picture, including HHVBP. What patients say about communication, care from providers, and overall rating is the survey — meaning the way you talk to patients, explain the plan of care, and follow through shows up in the agency's public scorecard.

The case-mix group a 30-day period falls into under PDGM.

Under PDGM there are 432 possible case-mix groups, each defined by a combination of clinical grouping, functional impairment level, admission source, and timing. The combination of OASIS answers and claim data places each 30-day period of care into one HHRG, and the HHRG drives the payment amount for that period. You do not pick the HHRG directly — it falls out of the OASIS and the diagnoses on the claim, which is why coding and OASIS accuracy matter so much to the agency.

Medicare adjusts agency payment up or down based on quality scores.

HHVBP is a CMS program that ties a portion of an agency's Medicare payment to its quality performance compared to other agencies. It ran as a nine-state pilot starting in 2016 and expanded nationwide effective January 1, 2023. Scores are built from OASIS-based outcome measures, claims-based measures, and HHCAHPS results. In plain English: the OASIS you complete and the way patients rate their experience feed scores that move the agency's payment rate up or down. Your documentation quality is not abstract — it directly affects what the agency gets paid.

The 5-character code on the claim that represents the case-mix group.

HIPPS (Health Insurance Prospective Payment System) codes are 5-character alphanumeric codes that appear on the home-health claim and encode the HHRG plus other case-mix information for that 30-day period. Clinicians rarely interact with the HIPPS code directly — the EMR's grouper software generates it from the OASIS and the diagnoses. It is the piece that carries your OASIS answers all the way through to the bill.

Medicare coverage cornerstone — two criteria, both required.

Medicare homebound status requires two criteria, both of which must be documented. Criterion 1: the patient needs the help of supportive devices (walker, wheelchair, crutches), special transportation, or another person to leave home, OR leaving home is medically contraindicated. Criterion 2: there exists a normal inability to leave home, AND leaving home requires a considerable and taxing effort. Homebound does not mean bedbound — short, infrequent absences for medical care, religious services, adult day care, or occasional non-medical reasons (haircut, family event) are allowed. Auditors fail agencies for documenting only one of the two criteria.

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A 30-day period with too few visits gets paid per-visit instead.

Under PDGM, each 30-day period of care has its own LUPA threshold — somewhere between 2 and 6 visits, depending on the patient's case-mix group (HHRG). If the period falls below that threshold, it is paid per-visit at standard rates instead of the full case-mix payment, which is usually a meaningful drop in revenue. LUPAs are not failures (sometimes the patient genuinely needed few visits), but agencies watch the threshold closely, and the threshold differs from patient to patient.

A one-time notice the agency files with Medicare to open a billing period.

The Notice of Admission replaced the old Request for Anticipated Payment (RAP) effective January 1, 2022. The agency must submit the NOA to its Medicare Administrative Contractor within 5 calendar days of the Start of Care date. Missing that window triggers a payment reduction for each day the NOA is late, calculated against the 30-day period payment. Clinicians do not file the NOA themselves, but a late SOC OASIS or delayed admission paperwork is what causes most late NOAs — so timely SOC documentation is a billing event, not just a clinical one.

The big, regulated assessment data set.

A standardized Medicare-required data set completed at Start of Care, Resumption of Care, Recertification, Transfer, and Discharge. OASIS drives payment, quality scoring, and outcomes reporting. It is also the heaviest piece of documentation in the field, which is why it has its own chapter.

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The Medicare home-health payment model since 2020.

Replaced the old episode-based payment with a 30-day payment unit driven by patient characteristics (clinical grouping, functional level, admission source, timing). PDGM changed what gets paid and how, which is why your agency is so attentive to the details on the OASIS and the timing of admissions.

Flat rate per completed visit.

A compensation structure where you are paid a flat rate for each completed visit, with different rates by visit type (a Start of Care admission with its OASIS pays more than a routine follow-up). Rewards efficient, well-routed clinicians; punishes light schedules and no-shows.

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The physician-signed orders driving the episode.

The document that lays out the patient's diagnoses, medications, services ordered, visit frequencies, and goals, signed by the physician or allowed practitioner. Federal content requirements live at 42 CFR 484.60. Older clinicians still call it "the 485" from the historic HCFA-485 / CMS-485 form; most agencies now manage the plan of care inside their EMR. Your visits, your documentation, and the patient's eligibility all map back to it, and care that drifts from the POC creates billing and compliance problems.

Charting in the home, while it's happening.

Documenting the visit on the device in your hand, in the home, while it is happening — rather than reconstructing it from memory later. The single highest-leverage habit in home-health time management. (Note: "POC" most often means Plan of Care; this sense is usually clear from context.)

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On-call, occasional work.

A staffing arrangement in which you take visits as they come, without a fixed weekly schedule. PRN per-visit rates are commonly set higher than the per-visit equivalent for salaried clinicians at the same agency, partly as a premium for on-demand availability and partly to make up for the lack of benefits. PRN clinicians often work for more than one agency at once.

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Agency scoring that weighs visits by type.

Many agencies score visits on a points system (an admission with its OASIS is worth more points than a routine follow-up) rather than counting raw visit numbers, and set a points target per week. Knowing your agency's point values is essential to understanding what your day is actually worth.

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Renewing the episode for another 60 days.

If the patient still qualifies for skilled care at the end of an episode, a recert OASIS is completed to extend coverage for another 60 days. There is no automatic limit on how many recerts a patient can have — only the requirement that they still need skilled care and remain homebound.

Re-opening the episode after a hospital stay.

When a home-health patient is admitted to the hospital (or other inpatient setting) during an open episode and returns home, a Resumption of Care OASIS is completed within 2 calendar days of the patient's return — or, if the agency does not know the patient is back, within 2 days of the agency learning about the return. (Many clinicians say "48 hours," but CMS uses calendar days.) The episode resumes and care continues under the same plan, updated for what changed during the stay.

The clinical justification for the visit.

Medicare pays for home-health care because it requires the skill of a licensed clinician. Each visit's documentation has to make that skill visible: the assessment, the teaching, the clinical judgment that an untrained person could not provide. "Patient is stable" without showing the skilled work is the fastest path to a denial.

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The first visit and the first OASIS.

The opening of a home-health episode: an admission visit with the Start of Care OASIS, the plan of care, the teaching, the safety walk-through. It is the longest, heaviest, and most important visit in the episode — the document of record for everything that follows.

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Therapy assistants in home health practice under a supervising therapist.

Physical therapist assistants, certified occupational therapy assistants, and speech-language pathology assistants provide therapy visits under the supervision of the licensed therapist. The required frequency and form of supervision (chart review, on-site supervisory visits, joint visits) come from the state practice act, the home-health Conditions of Participation, and Medicare-specific rules. Your visit notes need to reflect the supervision arrangement — who the supervising therapist is, when the last supervisory visit occurred, and that orders are being followed. Requirements vary meaningfully by state, so check your state practice act for the specifics that apply to you.

Employee vs. independent-contractor tax status.

A W-2 employee has taxes withheld by the agency; a 1099 contractor handles their own taxes including self-employment tax and quarterly estimated payments. 1099 work has higher gross pay and the mileage deduction as upsides; the downsides are no benefits, no withholding, and discipline required. Talk to a tax professional before your first 1099 year.

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