PDGM for home health
Preparing for success and beyond.
We’re here for you. And we want to make sure you’re equipped with the software and services you need to handle the biggest change in decades – including a whole new set of requirements that could put the squeeze on your productivity and profits.
What is PDGM? Patient-Driven Groupings Model (PDGM) is the new Home Health Groupings Model (HHGM) – which was the original iteration of this final rule.
A quick overview of significant changes:
- The Payment Periods: 30-day periods instead of 60-day episodes
- The LUPA Threshold: Unique LUPA thresholds from 2-6 visits for each of the 432 HIPPS codes
- The Clinical Grouping: 12 Clinical Groups based on primary diagnosis code
- The Comorbidity Coding: No, low or high comorbidity adjustment based on secondary diagnoses
- The Timing: Early periods for first 30-day period only, anything beyond 30 days considered late
- The Admission Source: Patients will be classified as either institutional or community based on 14-day look-back from the start date
- The Billing: RAPs and final claims submitted every 30 days instead of every 60 days
- Behavior Adjustments: CMS proposing behavior adjustment reducing payment by 6.42% based on expected behavior changes for LUPA utilization and coding.
Check out these resources to see how our automated software is the perfect tool to tackle PDGM’s shorter billing cycles, new LUPA thresholds and complex coding requirements.