Home Health Care Agencies: Are you ready for PDGM?

What is PDGM?

Patient-Driven Grouping Model (PDGM) is the new payment model for the Home Health Prospective Payment System (HH PPS). With PDGM, CMS has significantly changed how home healthcare agencies will be reimbursed for delivering care.  PDGM relies more on claims data and less on OASIS data for reimbursements. Only 8 elements from OASIS are used for determining reimbursements.

PDGM will redefine the episode into two 30-day payment periods, change LUPA visits based on HIPPS Code, and exclude therapy visits to calculate reimbursement.

CareVoyant will be implementing software enhancements to help Home Healthcare Agencies to stay efficient and compliant in the PDGM world.

Key Factors in PDGM:

The following are the key factors in the new PDGM Model (Source and Count in parenthesis):

• Timing (Claims, 2)

• Admission Source (Claims, 2)

• Clinical Grouping (Claims, 12)

• Functional Impairment Level (OASIS, 3)

• Comorbidity Adjustment (Claims, 3)

PDGM will have 432 payment groups replacing the current 153 HHRG codes.

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Key Process Changes for Agencies in PDGM:

The following are the key areas agencies should monitor in PDGM:

• Admission Source

• Clinical Grouping

• Comorbidity Coding

• LUPA Threshold and Adjustments

• Timely Billing of RAP and Final Claims

CareVoyant Enhancements for PDGM:

CareVoyant will be implementing the following software enhancements to help Home Healthcare Agencies to stay efficient and compliant in the PDGM world.

• Admission Source: CareVoyant will have options to maintain and update Inpatient Discharges during the episode of care.

• Clinical Grouping and Comorbidity: CareVoyant will have options to maintain and manage unlimited ICD-10 codes for the episodes and payment periods.

• PDGM Analysis: CareVoyant will have options to calculate and analyze PDGM HIPPS Codes at the Point of Care enabling clinicians to review and adjust in real-time.

• PDGM Monitor: CareVoyant will have options to monitor PPS Episodes and Payment Periods in real-time with key exceptions and indicators.

• PDGM Billing Manager: CareVoyant will have options to review and manage payment periods in real-time with exceptions significantly improving timely billing of RAP and Final Claims.

• Real-Time Alerts and Dashboards: CareVoyant will provide real-time alerts and dashboards with key indicators to manage PDGM Episodes.

ABOUT CAREVOYANT

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.