Episodic Payment
Episodic payment is a reimbursement model in which a home health agency receives one predetermined amount for an entire episode or period of care, regardless of the number of visits delivered within it. Medicare pays this way for 30-day periods under the Patient-Driven Groupings Model (PDGM), and some Medicare Advantage and commercial contracts use episodic structures as well. The model shifts utilization risk from the payer to the agency.
Definition
Episodic payment is a reimbursement model in which a home health agency receives one predetermined amount for an entire episode or period of care, regardless of the number of visits delivered within it. Medicare pays this way for 30-day periods under the Patient-Driven Groupings Model (PDGM), and some Medicare Advantage and commercial contracts use episodic structures as well. The model shifts utilization risk from the payer to the agency.
Why it matters
Episodic Payment is part of the Revenue Cycle & Billing vocabulary used across home health operations, documentation, and revenue cycle. Understanding it helps clinicians, QA leads, and administrators stay aligned on care quality and compliance.
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