Start of Care (SOC)

Start of Care (SOC) is the date of the first billable visit in a home health episode, and the name of the OASIS assessment completed at that point. The SOC date anchors nearly every downstream deadline: the comprehensive assessment window, the Notice of Admission, the 60-day certification period, and the first 30-day PDGM payment period.

What has to happen at start of care

A cluster of requirements attaches to the SOC date:

Initial assessment visit within 48 hours of referral, within 48 hours of the patient's return home, or on the physician-ordered SOC date
Comprehensive assessment, including the SOC OASIS, completed within 5 days after the SOC date
Face-to-face encounter confirmed within 90 days before or 30 days after SOC, related to the primary reason for home health
Plan of care established under orders from the certifying practitioner
Notice of Admission (NOA) submitted within 5 calendar days of SOC

How SOC sets the payment clock

The SOC date opens a 60-day certification period containing two 30-day PDGM payment periods. The first 30-day period is classified as early, with all subsequent periods late, one of the dimensions that builds the 432 PDGM case-mix groups along with admission source, clinical grouping, functional impairment level, and comorbidity adjustment. A late NOA is expensive: Medicare reduces payment for each day the NOA is late. Getting SOC right also means getting it on the right date, since backdating or drifting SOC dates ripple through certification spans, recertification windows, and claims.

SOC as a referral conversion and quality event

Referral sources watch how fast agencies get to the patient, and so does CMS. Timely initiation of care is a publicly reported process measure built on whether care started within the required timeframe, and slow starts are a leading reason hospital discharge planners shift referrals elsewhere. Operationally, SOC timeliness depends on intake speed, eligibility verification, scheduling capacity, and clinician availability in the patient's territory. Agencies that treat SOC as a same-or-next-day service standard tend to win both the quality measure and the referral relationship.

Common SOC pitfalls

The recurring failure modes are procedural, not clinical: starting care before eligibility and the face-to-face encounter are verified, letting the SOC OASIS slip past the 5-day window, submitting the NOA late and eating a per-day payment reduction, and mismatches between the SOC date on the assessment, the plan of care, and the claim. A tight intake-to-SOC checklist with clear ownership, plus daily tracking of unstarted referrals, prevents most of them.

Frequently asked questions

Who can perform the SOC visit?

An RN conducts the initial and comprehensive assessment when nursing is on the order. For therapy-only cases, a physical therapist or speech-language pathologist may conduct it, and an occupational therapist may do so when OT is part of the ordered services. The assessing clinician must be qualified to complete OASIS.

Is the SOC date always the first visit date?

Yes. SOC is the date of the first billable service, regardless of which discipline delivers it. An administrative or non-billable contact does not establish SOC.

What happens if the NOA is filed late?

Medicare applies a payment reduction for each day from the SOC date until the NOA is submitted, unless the agency qualifies for an exception. On a 30-day period, even a few late days meaningfully cut revenue, so most agencies track NOA submission daily.