Visit Threshold
Minimum number of billable skilled visits required during a PDGM 30-day payment period.
Definition
A Visit Threshold is the minimum number of billable skilled visits required during a PDGM 30-day payment period to avoid a LUPA adjustment. CMS assigns a threshold ranging from 2 to 6 visits, depending on the patient's payment group.
Why it matters
Knowing the threshold helps agencies schedule visits appropriately while meeting patient needs and avoiding unnecessary payment reductions.
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Episodes from Inside Home Health that put Visit Threshold in operational context.
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