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Home Health Glossary

Plain-English definitions for the Medicare home health terms agencies, clinicians, and billers use every day - written by the team building EMRxAI.

CMS-2567 (Statement of Deficiencies)
The form surveyors use to document deficiencies found during a home health survey. The agency responds with a plan of correction, generally due within 10 calendar days of receiving the 2567. Learn more
Conditions of Participation (CoPs)
The federal requirements in 42 CFR Part 484 that home health agencies must meet to participate in Medicare, covering patient rights, comprehensive assessment, care planning, QAPI, infection control, and more. Learn more
Electronic Visit Verification (EVV)
Required by the 21st Century Cures Act for Medicaid-funded home health visits. EVV electronically confirms the type of service, the patient, the date, the location, the caregiver, and the start and end time.
Face-to-face encounter
A required encounter related to the primary reason for home care, performed no more than 90 days before or within 30 days after the start of care, and documented by the certifying practitioner.
HHCAHPS
The Home Health Care Consumer Assessment of Healthcare Providers and Systems survey - the standardized patient experience survey that feeds patient survey star ratings and HHVBP scores.
Home Health Value-Based Purchasing (HHVBP)
The expanded Medicare model, nationwide since January 1, 2023, that adjusts home health payments up or down based on quality performance across OASIS, claims-based, and HHCAHPS measures. Learn more
Homebound status
A Medicare eligibility requirement: leaving home requires considerable and taxing effort, and the patient needs assistance, a device, or special transportation, or leaving home is medically contraindicated.
iQIES
The Internet Quality Improvement and Evaluation System, the CMS platform home health agencies use to submit OASIS assessments. Completed assessments must be submitted within 30 days.
LUPA (Low Utilization Payment Adjustment)
Under PDGM, when a 30-day period has fewer visits than the case-mix group's threshold (2 to 6 visits), Medicare pays per visit instead of the full period payment. Learn more
Medicare Administrative Contractor (MAC)
The private contractor that processes Medicare home health claims and NOAs for a region and conducts medical review.
Notice of Admission (NOA)
A one-time submission (type of bill 32A) that establishes a home health admission with Medicare. It must be accepted within 5 calendar days after the start of care or the agency loses payment for each late day. Learn more
OASIS (Outcome and Assessment Information Set)
The standardized patient assessment required at start of care, resumption of care, recertification, transfer, and discharge. OASIS-E1 has been the current version since January 1, 2025. Learn more
PDGM (Patient-Driven Groupings Model)
The Medicare home health payment model since January 1, 2020. It pays per 30-day period using 432 case-mix groups built from admission source and timing, clinical grouping, functional impairment, and comorbidity adjustment. Learn more
Plan of care
The individualized, practitioner-signed order set covering diagnoses, services, frequency, goals, and medications. Historically filed on the CMS-485 form.
Plan of correction (PoC)
The agency's written response to each deficiency on a CMS-2567: what will be fixed, how recurrence will be prevented, who is responsible, and by what date. Learn more
QAPI (Quality Assessment and Performance Improvement)
The CoP (42 CFR 484.65) requiring an agency-wide, data-driven program that tracks quality indicators, adverse events, and performance improvement projects. Learn more
Recertification
Renewal of a patient's 60-day certification period. The recertification OASIS must be completed during the last 5 days of the period (days 56-60). Learn more
Resumption of care (ROC)
The OASIS assessment completed within 2 calendar days after a patient returns home from an inpatient facility stay of 24 hours or longer.
Review Choice Demonstration (RCD)
A CMS program in selected states (including Illinois, Ohio, Texas, North Carolina, Florida, and Oklahoma) requiring home health agencies to choose pre-claim or post-payment review options.
Home health Star Ratings
The 1-to-5 star quality of patient care ratings published on Medicare Care Compare, calculated largely from OASIS-based outcome and process measures. Learn more
Start of care (SOC)
The date of the first billable visit. The comprehensive SOC assessment must be completed within 5 calendar days after this date. Learn more