Preparing for PDGM

Preparing for PDGM

Implementation of the Patient-Driven Groupings Model (PDGM) is only ten months away! To help providers prepare, CMS conducted a provider call on February 12 outlining PDGM and clarifying some elements of the system:

      • The change to the 30-day payment period with PDGM only affects payment. There are no changes to the timing of certification/recertification, completion of OASIS assessments or updates to the patient’s plan of care, all of which continue to be done on a 60-day basis.
      • Late 30-day periods are always classified as a Community admission, unless there is an acute hospitalization in the 14 days prior to the beginning of the late period. A post-acute stay (e.g., SNF, IRF, LTCH, IPF) in the 14 days prior to a late home health 30-day period is not classified as an Institutional admission unless the patient has been discharged from the home health agency prior to the post-acute stay.
      • Clinical Grouping is determined by the primary diagnosis on the claim and it represents the primary reason for home health, but it is not the only reason. Therapy may be needed and provided for a patient in a clinical group other than Musculoskeletal or Neuro/Stroke Rehab.
      • For implementation purposes, 60-day episodes that begin on or before December 31, 2019 and end on or after January 1, 2020 will be paid the CY 2020 national, standardized 60-day episode payment amount. Thirty-day periods of care that begin on or after January 1, 2020, will be paid the CY 2020 national, standardized 30-day payment amount.

For more information and a link to the presentation, recording, and transcript of the call, click here.

Holly Hester

Holly Hester is Casamba’s Senior Vice President of Compliance & Education, as well as the Compliance Officer. She provides regulatory guidance and interpretation, clinical programming and content development, education and training steerage, and compliance support for the company. As a physical therapist for more than 20 years, Holly has multi-venue clinical and management experience, giving her a unique perspective on the integration of compliance and training with therapy service delivery and clinical practice.
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