ROC (medical abbreviation for Resumption of Care) visits are a critical piece of the home health puzzle, especially in 2025. Recent regulatory updates and evolving practices mean ROC is much more than a compliance formality.
Here, we’ll break down the basic Centers for Medicare & Medicaid Services (CMS) guidelines for resumption of care, as well as how to get it exactly right.
Understanding Resumption of Care (ROC): Why It Still Trips Up Even the Pros
ROC, in the context of home health care, is the reassessment of a patient who has returned home after being in an inpatient facility for 24 hours or more. The evaluation should be performed within the first two days of the discharge and helps clinicians identify necessary changes in ongoing services.
ROC serves as a keystone in health care transitions, allowing clinicians and nurses to stay on the same page while moving on to a new chapter. Delays or omissions can result in fragmented care and unpredictable outcomes.
Skipping resumption of care guidelines for home health can also lead to issues in billings: Value-based care models won’t hesitate to deny claims if a provider hasn’t taken the necessary steps for a transition. Or, of course, if the outcome wasn’t the one expected.
The CMS specifically accounts for ROC in its Quality Assessments Only (QAO) formula. This forms part of the Outcome and Assessment Information Set (OASIS), meaning providers can face severe compliance issues if ROCs aren't performed correctly.
It also defines ROCs as the first step in beginning a new “quality episode.” The evaluation of each quality episode can impact performance metrics and ratings across the board.
Starting July 1st, 2025, CMS makes it mandatory to collect and submit resumption of care OASIS data for all patients. ROCs aren’t just a checkbox; they are a key part in keeping compliance and quality scores.
When and How to Perform a Resumption of Care
A ROC assessment is required whenever the patient returns from an inpatient stay of 24 hours or more. There are some exceptions for:
- Maternity patients
- Patients under 18
- Patients receiving only housekeeping services
- Patients receiving only a single visit in a quality episode
- Patients staying in the hospital for diagnostic testing
The visit must occur within 48 hours of the patient returning home or within two calendar days of the discharge. A physician may arrange for a specific date over the two-day window, but the order must be communicated prior to the end of those 48 hours.
Home health resumption of care regulations dictate that ROC assessments must be completed by one of the following qualified professionals or skilled services:
- Registered Nurse (RN)
- Physical Therapist (PT)
- Occupational Therapist (OT)
- Speech-Language Pathologist (SLP)
Licensed Practical Nurses (LPNs), Physical Therapist Assistants (PTAs), and Occupational Therapy Assistants (OTAs) are not eligible to perform an ROC assessment.
Usually, the ROC is performed by the most relevant professional handling the home health care services.
In cases of therapy-only services, the specific discipline (PT, OT, or SLP) should handle the assessment. If post-acute care and skilled nursing are needed, RNs may be a better option. Some agencies rely on RNs almost exclusively for ROC evaluations, as they can connect multiple skilled disciplines into a holistic picture of the situation.
Common Resumption of Care Mistakes (And How to Fix Them)
It’s not uncommon for resumption of care to go off track. Small mistakes, such as documentation gaps, can snowball into compliance issues, so keeping a close eye on the whole process is paramount for successful quality episodes. Here are common ROC mistakes and how to fix them.
Mistake #1: Missing the ROC Window
Maybe the most frequent error in ROC is delaying or missing the CMS-mandated 48-hour window. Going over this time frame (unless excused by a doctor’s order) jeopardizes billing and compliance quality.
Providers should schedule ROC visits as soon as possible — ideally as soon as the patient is discharged. Documenting time stamps helps track ROC windows, as well as setting up automated alerts after a discharge.
Mistake #2: Incomplete or Incorrect OASIS-E Documentation
Vague clinical notes, skipped sections, misreported items, outdated guidelines — the list goes on. OASIS-E data and documentation can be subject to hundreds of unnoticed mistakes that can impact reimbursements and quality scores.
Providers should thoroughly train staff on current OASIS-E guidelines and LPTAC regulatory changes. Structured workflows can also give professionals a clear path toward thorough, accurate documentation.
Mistake #3: Failing To Update the Care Plan Based on New Needs
ROC is about meeting critical patient changes with care plan adjustments. When providers fail to revise plans, quality outcomes and compliance will take a hit.
Providers should revise care plans as soon as the ROC assessment is finished. Meet newly identified needs as soon as possible to stay aligned with CMS transitional care management requirements.
Mistake #4: Poor Communication Between Care Teams
Breakdowns in communication lead to fragmented care. Missing discharge summaries or unclear documentation can cause patient safety risks or even readmissions. Critical information, unfortunately, can easily get lost in translation.
Setting up EHR support for CMS guide model, shared documentation, and real-time updates in your platforms helps team members get instant access to all relevant data and details. In essence, this means ensuring coordination and continuity across the board.
Mistake #5: Losing Revenue from Improper or Missed ROC Billing
Missbilling or skipping ROC visits can cause a direct impact on revenue and reimbursements. Even small timing errors or using the wrong ICD-10 codes for SNFs can quickly compound into flawed CMS claims that end up in denial.
At ChartPath, we use an integrated RCM + EHR system to track returns and assessments and automate billing initiation. This ensures clean submissions even when sensitive data is being handled by several professionals at once.
Mistake #6: Treating ROC as Just a Checkbox
Many providers treat ROC visits and assessments as a mere formality that only exists because of the CMS. However, the resumption of care meaning is clear: handling safe patient transitions back home.
As such, ROC should be approached with your full clinical intent. Involve both patients and professionals in setting goals, and try to ensure a clear schedule to satisfy actual needs instead of just timing requirements.
