The Difference Between Start of Care, Recertification, and Resumption of Care in Home Health Documentation

SOC, recertification, and resumption of care in home health documentation are three distinct visit types with different requirements, different OASIS assessment timepoints, and different documentation standards. Confusing them or applying the same documentation approach to all three is one of the more consistent sources of chart errors in home health. This post breaks down exactly what each one is, what the documentation requires, and where things most commonly go wrong.

Start of Care (SOC)

What it is

A Start of Care is the beginning of a new home health episode for a patient who is newly admitted to the agency or who is returning after a discharge. The SOC OASIS assessment establishes the clinical and functional baseline for the entire episode and drives the initial PDGM payment grouping.

What the documentation requires

The SOC requires a complete OASIS assessment completed within 48 hours of the first skilled visit or by the end of the second calendar day after the start of care, whichever is earlier. The physician's MD Order must be in place before care begins. The Plan of Care must reflect the skilled services ordered, and all five chart components, OASIS, ICD-10 coding, medication list, provider documentation, and Plan of Care, must be internally consistent and aligned with the MD Order before submission.

What commonly goes wrong

At SOC, the most frequent documentation problem is an OASIS completed before the MD Order is finalized, resulting in responses that do not match the order the physician ultimately signs. The second most common issue is a Plan of Care that lists visit frequencies different from what the physician ordered. Both are preventable with a structured review before the Plan of Care is submitted.

Recertification (RC)

What it is

A recertification occurs at the end of a 60-day certification period when the patient continues to need skilled home health services. The recertification OASIS, also called the Follow-Up OASIS or OASIS-E Recertification, reassesses the patient's current clinical and functional status and establishes the documentation basis for the next 60-day period.

What the documentation requires

The recertification OASIS must be completed between days 56 and 60 of the current certification period. A new Plan of Care must be established for the next period, reflecting any changes in the patient's condition, skilled needs, or visit frequencies. The physician must re-certify that the patient continues to meet home health eligibility requirements. The MD Order for the new period must be current and must match the Plan of Care being submitted.

What commonly goes wrong

Start of care vs recertification home health documentation errors at recertification most often involve a Plan of Care that carries forward the same visit frequencies from the prior period without reflecting a reassessment of the patient's current needs. A patient who has improved significantly should not have a recertification Plan of Care identical to their SOC Plan of Care without clinical documentation supporting why the same level of service is still required. Surveyors and auditors look for evidence that the recertification reflects a genuine reassessment, not a copy-forward of the prior period.

Resumption of Care (ROC)

What it is

A Resumption of Care occurs when a patient who was discharged from home health services during an active certification period is readmitted to the same agency within the same 60-day period. The most common scenario is a patient who is hospitalized and then returns to home health services after discharge. The ROC OASIS documents the patient's condition at the point of return.

What the documentation requires

The ROC OASIS must be completed within 48 hours of the resumption of care or by the end of the second calendar day after the return, whichever is earlier. A new or updated Plan of Care must reflect any changes in the patient's condition resulting from the hospitalization or intervening event. New physician orders must be obtained that reflect the patient's current clinical status and any new skilled needs identified.

What commonly goes wrong

Home health visit type documentation differences are most significant at ROC. The most common error is treating the ROC like a continuation of the prior episode without updating the Plan of Care to reflect what changed during the hospitalization. If a patient was hospitalized for a new diagnosis, that diagnosis must be reflected in the updated ICD-10 coding, OASIS responses, and Plan of Care. A resumption of care home health chart that looks identical to the pre-hospitalization documentation is a chart that does not accurately reflect the patient's current condition.

How Visit Type Affects Pre-Submission Review

Each of these three visit types requires the same structured pre-submission review, but the specific questions being asked are different depending on the visit type.

For SOC the question is whether the initial baseline documentation is internally consistent and aligned with the MD Order. For recertification the question is whether the documentation reflects a genuine reassessment of the patient's current status. For ROC the question is whether the documentation captures what changed and whether the Plan of Care has been updated accordingly.

LS Consulting Solutions reviews all five chart components before the Plan of Care reaches the physician for SOC, recertification, and resumption of care submissions. Written findings are delivered to your Director of Nursing for independent review. Contact us to learn how the pre-submission review process works for your agency.