Resources
Home Healthcare Glossary
47 key terms and definitions for home healthcare technology, compliance, billing, and operations.
Clinical
OASIS-E
Outcome and Assessment Information Set, Edition E — the standardized assessment tool required by CMS for home health patients in the US. Covers clinical, functional, and service utilization data. OASIS-E2 is the latest version effective January 2025.
SOAP Notes
Subjective, Objective, Assessment, Plan — the standard format for clinical documentation in healthcare. Each section captures different aspects of a patient encounter.
ADL (Activities of Daily Living)
Basic self-care tasks including bathing, dressing, eating, toileting, transferring, and continence. Used to assess patient functional status and determine care needs.
IADL (Instrumental Activities of Daily Living)
Complex daily tasks including meal preparation, housekeeping, laundry, medication management, finances, transportation, and telephone use. Higher-level functioning than ADLs.
Care Plan
A documented plan of care outlining patient goals, interventions, and expected outcomes. Updated regularly based on patient progress and reassessment.
SOC (Start of Care)
The first visit to a patient by a home health agency, during which the initial comprehensive assessment is completed and the plan of care is established.
ROC (Resumption of Care)
When a patient returns to home health services after a hospitalization or other inpatient stay within the same 60-day episode.
Ambient Documentation
AI technology that listens to clinician-patient conversations during visits and automatically generates structured clinical notes. The clinician reviews and approves the output.
Braden Scale
A standardized tool for assessing pressure ulcer risk. Evaluates sensory perception, moisture, activity, mobility, nutrition, and friction/shear on a scale of 6-23.
Barthel Index
A scoring system that measures a patient's ability to perform activities of daily living. Scores range from 0 (totally dependent) to 100 (fully independent).
Visit Mode
A single-screen clinical documentation workspace designed for field use, containing all documentation tasks (vitals, meds, assessments, notes) in expandable sections.
PHQ-9
Patient Health Questionnaire-9, a validated screening tool for depression severity. Scores range from 0-27, with higher scores indicating more severe depression.
Deterministic AI
AI approach where safety-critical decisions follow explicit, documented rules with predictable outputs. Unlike probabilistic AI (e.g., LLMs), deterministic clinical rules always produce the same result for the same input. Used in Residora for clinical instruments.
Billing & Financial
PDGM
Patient-Driven Groupings Model — Medicare's payment methodology for home health services. Replaces the former PPS system, grouping patients by clinical characteristics, functional impairment, and comorbidity.
837P
The HIPAA-standard electronic claim format for professional services. Used to submit home health claims to Medicare, Medicaid, and commercial payers. Related formats: 837I (institutional), 835 (remittance), 997 (acknowledgment).
LUPA (Low Utilization Payment Adjustment)
A reduced Medicare payment that occurs when a home health episode has fewer visits than the threshold (typically 2-6 visits depending on the PDGM group). Agencies lose significant revenue per LUPA episode.
ERA/835
Electronic Remittance Advice — the electronic equivalent of an Explanation of Benefits (EOB). Contains payment information, adjustments, and denial reasons from payers.
Denial Management
The process of identifying, appealing, and preventing claim denials. Includes tracking denial reasons (CARC/RARC codes), filing appeals, and implementing process changes.
AR Aging
Accounts Receivable Aging — a report categorizing outstanding claims by how long they have been unpaid (30, 60, 90, 120+ days). Used to prioritize collection efforts.
Revenue Per Episode
The average revenue generated per home health episode. A key financial metric for agency profitability analysis.
Charge Capture
The process of recording billable services at the point of care. Automated charge capture generates charges directly from documented visits.
Claims Scrubbing
Automated review of claims before submission to identify and correct errors that would cause denials. Includes checking for missing data, coding errors, and payer-specific rules.
Timely Filing
The deadline by which a claim must be submitted to a payer after the date of service. Deadlines vary by payer (typically 90-365 days). Claims submitted after the deadline are denied.
EDI
Electronic Data Interchange — the electronic exchange of business documents (claims, remittances, eligibility checks) in standardized formats between healthcare providers and payers.
Compliance & Regulatory
HIPAA
Health Insurance Portability and Accountability Act — US federal law establishing national standards for protecting sensitive patient health information. Requires administrative, physical, and technical safeguards.
EVV
Electronic Visit Verification — federally mandated system that electronically confirms home healthcare visits, capturing type of service, date, time, location, and caregiver identity. Required under the 21st Century Cures Act.
CQC
Care Quality Commission — the independent regulator of health and adult social care in England. Inspects and rates care providers including domiciliary care agencies.
NDIS
National Disability Insurance Scheme — Australia's national scheme for people with disability, providing funding for supports and services including home care.
PDPL
Personal Data Protection Law — data privacy regulations in GCC countries (Saudi Arabia, UAE, etc.) governing the collection, processing, and storage of personal data.
SOC 2 Type II
Service Organization Control 2 Type II — an auditing standard that evaluates a service organization's controls related to security, availability, processing integrity, confidentiality, and privacy over a period of time.
21st Century Cures Act
US federal law (2016) requiring states to implement EVV for Medicaid-funded personal care and home health services. Full enforcement began in 2023.
CoP (Conditions of Participation)
Federal requirements that home health agencies must meet to participate in Medicare and Medicaid programs. Surveyed by CMS-approved accreditation organizations.
GDPR
General Data Protection Regulation — EU/UK data protection law governing collection, processing, and storage of personal data. Requires lawful basis for processing, data minimization, and individual rights.
Privacy Act (Australia)
Australian federal law regulating the handling of personal information by organizations. Includes 13 Australian Privacy Principles (APPs).
Safeguarding
UK term for protecting adults at risk from abuse, neglect, and exploitation. Care providers must have safeguarding policies, training, and reporting procedures.
Technology & Platform
RLS
Row-Level Security — a database-level access control mechanism (e.g., PostgreSQL RLS) that ensures tenant data isolation at the database layer rather than the application layer. More secure than application-level filtering.
HL7/FHIR
Health Level Seven / Fast Healthcare Interoperability Resources — standards for exchanging electronic health information between systems. FHIR is the modern, API-based approach.
SSO/SAML
Single Sign-On / Security Assertion Markup Language — authentication protocols allowing users to access multiple applications with one set of credentials.
Webhook
An automated HTTP callback that sends real-time data to external systems when specific events occur (e.g., new referral, completed visit, claim status change).
Multi-Tenant Architecture
Software design where a single instance serves multiple organizations (tenants) while keeping each tenant's data completely isolated.
MFA (Multi-Factor Authentication)
Security method requiring two or more verification factors (password + phone code, biometric, etc.) to access an account.
Operations
Referral-to-Intake
The workflow from receiving a patient referral to completing intake assessment and admitting the patient to services. A key efficiency metric for agencies.
Census Management
Tracking the number of active patients across an agency. Includes monitoring admissions, discharges, and patient status changes.
Caseload Management
Assigning and balancing patient assignments across clinicians based on skills, geography, acuity, and workload capacity.
Call-Off Recovery
The process of reassigning visits when a scheduled clinician calls off. Measured by time-to-reassign and impact on patient continuity.
Provider Matching
Algorithm-based assignment of clinicians to patients considering skills, certifications, geographic proximity, language, patient preferences, and continuity of care.