LUPA & PDGM

    Episode of Care

    Period during which a patient receives coordinated home health services.

    Definition

    An Episode of Care refers to the period during which a patient receives coordinated home health services under a physician-authorized plan of care. Under PDGM, episodes are divided into consecutive 30-day payment periods.

    Why it matters

    Visit planning throughout the episode influences whether each payment period qualifies for full reimbursement or triggers a LUPA.

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    Conversations on lupa & pdgm

    Episodes from Inside Home Health that put Episode of Care in operational context.

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