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Discharge and Readmit for Home Health Services

Home health agencies (HHAs) may discharge beneficiaries before the 60-day episode has closed if all treatment goals of the plan of care have been met. The situation may occur when a beneficiary is discharged and returns to the same home health agency (HHA) within a 60-day episode.

When a beneficiary is discharged and readmitted within the same 60-day episode, the HHA will need to complete a new Outcome & Assessment Information Set (OASIS), plan of care (POC), RAP, and final claim (or NO-RAP LUPA in lieu of RAP and final claim).

HHAs will receive a partial episode payment (PEP) for the first episode to reflect the shortened period of care prior to the beneficiary's discharge. The next 60-day episode begins the date of the first billable visit under the readmission.

Please review the following information from the Medicare Claims Processing Manual, (Pub. 100-04, Ch. 10, § 10.1.14External PDF) regarding home care discharge due to an inpatient admission:

"Note that beneficiaries do not have to be discharged within the episode period because of admissions to other types of health care providers (i.e., hospitals, skilled nursing facilities), but HHAs may choose to discharge in such cases. If an agency chooses not to discharge and the patient returns to the agency in the same 60-day period, the same episode continues. However, if an agency chooses to discharge, based on an expectation that the beneficiary will not return, the agency should recognize that if the beneficiary does return to them in the same 60-day period, the discharge is not recognized for Medicare payment purposes. All the HH services provided in the complete 60-day episode, both before and after the inpatient stay, should be billed on one claim."

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Revised: 06.28.12


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