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.
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