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Patient-Driven Groupings Model Home Health Reimbursement

Speaker(s): Melinda. A Gaboury, CEO

Category: Speaking Engagement

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Speaker(s): Melinda. A Gaboury, CEO

Patient-Driven Groupings Model Home Health Reimbursement Jan 12
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About the Event

The Patient Driven Groupings Model (PDGM) went into effect January 1, 2020. This is the most massive change to the home care industry reimbursement structure since the introduction of the current Prospective Payment System (PPS) in October 2000. The new payment model dramatically impacts agency operations, processes and performance. January 2021 brings even more changes with the NO Pay RAP situation. Agencies must develop and implement plans to continue to succeed under PDGM. This workshop will discuss key areas, strategies and processes in preparing an agency for PDGM changes that will continue in 2021.

This workshop will have a focus on best episode management and process improvement practices including the referral, intake and scheduling processes, timely documentation, physician and patient communication strategies, all of which are required to more tightly manage care within the shorter 30-day payment period. The change to a 30-day payment model will brought significant back office changes, specific to the claims processing and collections, which will be one emphasis of this workshop. A strong clinical episode management program is critical to ensure sustained, efficient, cost-effective and uncompromised quality care delivery under the PDGM program!

Lastly, this workshop will review the full-blown emphasis of ICD-10 coding under PDGM and how agencies will have to monitor to ensure the specificity of coding for their patient care plans.


Summarize key Revenue Cycle Operations affected by PDGM changes.
Outline implementation actions in each key area.
Explain scheduling strategies to prevent penalties for Late RAPs in 2021
Discuss necessary modifications to the intake and referral process under PDGM
Present data to assist in determining financial impacts of PDGM on an agency.
Review strategies for improved physician interaction to ensure timely 30-day billing
Explain the importance of changing from 60 to 30-day payment periods under PDGM
Review the complexity of determining LUPA thresholds under PDGM
Discuss relevance of front-loading, missed visits and refusals of care and services to LUPA prevention
Review clinical management responsibilities related to LUPA prevention
Review the Impact of ICD-10 coding under PDGM
Explain the relevance of timely OASIS review, coding completion and clinician documentation under PDGM
Evaluate the specificity requirements of coding under PDGM
Outline the Impact on case-mix weight with one code versus another