Home Health PPS
The Home Health Prospective Payment System (HH PPS) is the method Medicare uses to pay home health agencies a predetermined, case-mix adjusted amount for each unit of care rather than reimbursing actual costs. Since January 2020 the unit of payment has been a 30-day period under the Patient-Driven Groupings Model (PDGM). Annual rulemaking updates the base rate, case-mix weights, wage index, and LUPA thresholds.
Definition
The Home Health Prospective Payment System (HH PPS) is the method Medicare uses to pay home health agencies a predetermined, case-mix adjusted amount for each unit of care rather than reimbursing actual costs. Since January 2020 the unit of payment has been a 30-day period under the Patient-Driven Groupings Model (PDGM). Annual rulemaking updates the base rate, case-mix weights, wage index, and LUPA thresholds.
Why it matters
Home Health PPS 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.
Home Health Documentation Playbook
The complete guide to OASIS-E, Medicare compliance, PDGM, and AI-assisted documentation. Learn how top agencies reduce documentation time without sacrificing compliance.
Related terms
Listen While You Read
Conversations on revenue cycle & billing
Episodes from Inside Home Health that put Home Health PPS in operational context.
