Home Health PDGM and OASIS-D1

Home Health PDGM  and OASIS-D1 

As a home health professional, you play a pivotal role in the reimbursement process. This course presents the Patient-Driven Groupings Model (PDGM), Medicare eligibility requirements, the role of the OASIS in reimbursement, and strategies that you can use to help optimize your agency’s reimbursement under the current payment system. This course discusses or references the home health OASIS data set. The version of this data set became the OASIS-D1 in January 2020. Throughout this course, we will use the general term OASIS in reference to the current version. The goal of this educational program is to provide nursing professionals and administrators in home health with information regarding PDGM and the OASIS-D1.


Hours: 1.25


Certificates provided by accrediting body (1 Match)

Texas Health and Human Services Commission

1.25 HOURS

Texas HHSC has determined that Relias Learning’s submitted training meets or exceeds the minimum standards for HCSSA administrator training in the following categories: Licensed and Certified Home Health (L&CHH). Texas HHSC also recognizes Relias Learning provides continuing education for administrators and alternate administrators. This activity is approved for 1.25 contact hours.

Course Details

Course Code: REL-PAC-0-HHPOD1
Hours: 1.25
Type: Online Course
Content Expiration Date: 1/31/2023
Learning Objectives:
Explain at least two situations in which different types of payment under the Medicare Home Health payment system would be applicable.
Describe at least three Medicare eligibility requirements for reimbursement in home health care.
Identify at least four OASIS completion requirements for Medicare reimbursement.
Describe at least three strategies to use to maximize reimbursement under PDGM.

Section 1: Introduction

About This Course

Learning Objectives

Section 2: The Medicare Home Health Payment System

The System

30-Day Periods


Home Health Resource Grouping

Clinical Grouping

Functional Score

Comorbidity Adjustment



Outlier Payments

Discharge Issues

Non-Routine Supplies (NRS)

Consolidated Billing



Section 3: Medicare Eligibility Requirements

Eligibility Requirements

Homebound Status

Plan of Care

Coverage for Skilled Nursing

Observation and Assessment

Managing the POC

Teaching and Training

Wound Care


Home Infusion Therapy

Other Nursing Services

Coverage for Therapy Services

The Face-to-Face Encounter



Section 4: The Role of OASIS

Comprehensive Assessment

OASIS Time Points

Who Completes the OASIS?



Section 5: Strategies for Success

Optimizing Reimbursement

Being Successful

Assessment Strategies

Completion of the OASIS

ADL Items

The Importance of Documentation



Section 6: Conclusion


Course Contributor




Instructor: Jennifer W. Burks, R.N., M.S.N.

Jennifer W. Burks, R.N., M.S.N. has over 25 years of clinical and teaching experience, and her areas of expertise are critical care and home health. She earned her Bachelor of Science in Nursing from The University of Virginia in 1993 and her Master of Science in Nursing from The University of North Carolina, Greensboro in 1996. Her professional practice in education is guided by a philosophy borrowed from Florence Nightingale’s Notes on Nursing, “I do not pretend to teach her how, I ask her to teach herself, and for this purpose, I venture to give her some hints.” 

Disclosure: Jennifer W. Burks, R.N., M.S.N. has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Administrators; Nurses; in the following settings: Home Health.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.