60-Day Certification Period

When PDGM took effect in January 2020, Medicare moved payment to 30-day periods but left the clinical and regulatory structure on a 60-day cycle. The practitioner certifies eligibility for 60 days, the plan of care spans those 60 days, and the comprehensive assessment follows the same rhythm. Billing, by contrast, happens twice per certification period: two 30-day payment periods, each with its own HIPPS code and claim. Keeping these two clocks straight matters operationally, because a single certification signature and plan of care must support two separate claims.

If the patient still needs care, the agency completes a recertification assessment during the last five days of the current period, days 56 through 60. The certifying practitioner must then recertify that the patient remains eligible, meaning still homebound with an intermittent skilled need, and must review and sign an updated plan of care covering the next 60 days. The recertification must also include an estimate of how much longer skilled services will be required. No new face-to-face encounter is needed at recertification; that requirement attaches to the initial certification.

Day 1 of the first certification period is the start of care (SOC) date, and subsequent periods run consecutively as long as the patient stays on service. A discharge followed by readmission starts a new certification period with a new SOC, a new face-to-face requirement, and a new admission timing status under PDGM. Transfers between agencies also reset the clock for the receiving agency. Agencies should watch patients whose hospitalizations straddle day 60, since the recertification window and a resumption of care assessment can collide.

The most expensive mistakes are missed recertification windows and late practitioner signatures. If the recertification assessment is not completed in the day 56 to 60 window, complete it as soon as the omission is found and document why; claims for the new period cannot be billed until a valid recertification is in place. Other pitfalls include plans of care that do not cover the full 60 days, ordered frequencies that do not match scheduled visits in the second 30-day period, and recertifying by habit without documenting continued skilled need, a pattern reviewers specifically look for.