FROM MY PT SCHOOL NOTES · HEALTHCARE SYSTEMS · UNIT 2 · CHAPTER 09
Home health: eligibility, OASIS and PDGM
09 Home health: eligibility, OASIS and PDGM How is home health reimbursement different from outpatient treatment?
Core ideas from class
- Original Medicare home-health coverage has distinct eligibility and certification requirements, including homebound status and a qualifying skilled need. OASIS supports standardized assessment; not every payer or patient situation uses the same rules.
- Homebound does not mean never leaving home. Brief or infrequent absences, including medical visits, may be compatible with homebound status, but the full criteria and individual circumstances matter.
- The Patient-Driven Groupings Model (PDGM) began January 1, 2020; payment uses 30-day periods and case-mix factors instead of historical therapy-visit thresholds.
Think like a PT
A patient attends a short medical appointment outside the house. Does that automatically invalidate homebound status? No—review the full circumstances and current program criteria.
Remember
Do not confuse the SNF PDPM with the home-health PDGM.
From my class sources: 12 Home Health.pdf. These are personal school notes with additional editorial context, not current legal advice, payer guidance, a coding manual, or a guaranteed reimbursement rule. Verify any current policy directly.
