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.
"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."
- Medicare Learning Network (MLN) Matters article, MM7338, “Revisions to the "Medicare Claims Processing Manual" - Chapter 10 (Home Health Agency Billing)”
- The Centers for Medicare & Medicaid Services (CMS) OASIS Considerations for Medicare PPS Patients information sheet (to assist HHAs with different patient care scenarios they may encounter and how these impact the collection and reporting of OASIS data for their Medicare beneficiaries in order to be reimbursed under the Home Health Prospective Payment System (HH PPS))
- Medicare Claims Processing Manual (CMS Pub. 100-04, Ch.10, §30.9)
- Avoiding Billing Errors Caused By Overlapping Home Health Episodes quick resource tool
- Special Billing Situations Under HH PPS quick resource tool