Patient Driven Groupings Model

Patient Driven Groupings Model

Patient Driven Groupings Model

Patient Driven Groupings Model

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DOT
The Patient Driven Groupings Model (PDGM) is the new payment system for Medicare certified home health agencies (HHAs) that was implemented for home health periods of care on or after January 1, 2020. It is a prospective payment system with a billing cycle of 30 days (rather than 60-day previous model) and utilizes a case-mix adjustment methodology, grouping patients into payment categories based on certain patient characteristics. With the reduced billing cycle period under PDGM, physicians’ orders will need to be signed and received sooner than the previous payment system; both proper coding and documentation will be pertinent to the new system as well as the timeliness in submission of care plans and orders.

COURSE INFORMATION

MedTrainer30 minValid for 12 monthsCreated 2020-04-24Updated 2020-04-24

Course Objectives

  • Explain the differences between the previous home health prospective payment system and the current Patient Driven Groupings Model (PDGM).
  • Understand the principles of PDGM, including admission source and timing.
  • Recognize clinical groups and coding under PDGM and identify functional impairment levels and comorbidity adjustments.
  • Explain the operational changes and the payment structure.
  • Understand diagnoses reporting and documentation.

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