PDGM and Team-based Health Care

The home health certification period (or home health episode of care) is how many days?

• 30 days

• 60 days

• 90 days

• 180 days

Face-to-Face Encounter by a physician or a qualified non-physician provider (e.g. Nurse Practitioner or Physician Assistant who is under the supervision of a physician) may be done

• 30 days after start of care

• 90 days before start of care

• both are correct

• none of the above

In the current payment model (Prospective Payment System or PPS) for home health services, payment is dependent on the number of therapy visits.

• True

• False

In PPS, the Low Utilization Payment Adjustment (LUPA) threshold is 5 visits.

• True

• False

When can a recertification assessment be done?

• Within 15 days of the end of a home health episode

• Within 10 days of the end of a home health episode

• Within 5 days of the end of a home health episode

• None of the above

In PDGM, the home health certification period (or episode of care) is how many days?

• 30 days

• 60 days

• 90 days

• 120 days

In PDGM, the payment period is every 30 days.

• True

• False

In PPS, Request for Anticipated Payment (RAP) is paid 60% of an expected 60-day episode payment for SOC (and 50% for Recertification), while in PDGM RAP is only paid 20% of expected payment for a 30-day payment period.

• True

• False

LUPA threshold in PDGM is 5 visits

• True

• False

In PDGM, Medicare payment for home health services depends on how many therapy visits the patient needs.

• True

• False