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Ready for PDGM?

Here's what home health providers need to know.

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Our team of seasoned home health experts developed resources, tools and guidance to help you prepare for – and master – the Patient-Driven Groupings Model (PDGM).

Extensive changes are on the horizon for home health providers. The Centers for Medicare and Medicaid Services (CMS) introduced PDGM, which takes effect on January 1, 2020, radically overhauling how home health services are reimbursed.

Explore

Take our brief quiz to see how much you know about PDGM fundamentals.

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Learn

Gain vital knowledge and insights about PDGM to learn how it will impact your organization.

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Strategize

Explore key strategies for addressing PDGM and its financial impact on your operation.

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Execute

The right technology is essential to succeeding with PDGM. We'll help you be more prepared.

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Applications to help you successfully navigate
your claims management under PDGM

All-in-one integrated claims and denial management and eligibility verification

Real-time, integrated claims management and eligibility verification, including remittance and audit and denial management – with up to a 99 percent clean claims rate.

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Easy-to-use claims management and patient payment acceptance

Simple, easy-to-use claims management and remittance functionality, including the ability to submit claims in batches.

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Batch eligibility and benefits verification

Manage all your patient eligibility and benefits verification in one place, along with an easy-to-read dashboard and advanced reporting to streamline your workflow.

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How will PDGM impact home health reimbursements?

CMS is laser-focused on transitioning healthcare from a fee-for-service to a value-based payment model. With the creation of PDGM, the course is set for major disruption to home health reimbursements. Take our quiz to test your knowledge and preparedness for PDGM.

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Not quite ... PDGM is effective at the beginning of the year — January 1, 2020.

Nicely done!
PDGM is effective at the beginning of the year — January 1, 2020.

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You almost had it!
PDGM was developed in response to the Bipartisan Budget Act 2018 mandate for home health payment reform by 2020.

Nailed it!
PDGM was developed in response to the Bipartisan Budget Act 2018 mandate for home health payment reform by 2020.

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Almost, but not quite right.
Per the proposed rule, therapy volume will no longer determine payment rates. The new model aligns payment with a broader range of clinical characteristics and patient needs. The goal is to eliminate incentives to over-provide therapy and emphasize value over volume.

Amazing!
Per the proposed rule, therapy volume will no longer determine payment rates. The new model aligns payment with a broader range of clinical characteristics and patient needs. The goal is to eliminate incentives to over-provide therapy and emphasize value over volume.

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So close!
Among the more significant adjustments home health agencies will need to make is shifting from 60-day episodes of care for payment to 30-day periods.

Correct!
Among the more significant adjustments home health agencies will need to make is shifting from 60-day episodes of care for payment to 30-day periods.

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Not exactly.
LUPA will dramatically change under PDGM and be based upon patient groups.

That's right!
LUPA will dramatically change under PDGM and be based upon patient groups.

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Ooh, so close!
Therapy service reimbursement will be impacted, but CMS has no assumption that therapy will be discontinued.

That's correct!
Therapy service reimbursement will be impacted, but CMS has no assumption that therapy will be discontinued.

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Almost there ... PDGM will increase the number of payment groupings and unique case-mix potential. The current 153 groupings will expand to 432. Each 30-day period will be categorized into one of the 432 Home Health Resource Groups (HHRGs).

Spot on!
PDGM will increase the number of payment groupings and unique case-mix potential. The current 153 groupings will expand to 432. Each 30-day period will be categorized into one of the 432 Home Health Resource Groups (HHRGs).

You got # out of 5 answers right!

Learn more about PDGM and how you can navigate the change by speaking with our revenue cycle expert.

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Ready to see how ABILITY can improve your claims and revenue cycle?