Success is possible under PDGM, prepare your agency with the PDGM Impact Anaylsis.

The data and insights provided by your custom PDGM Impact Analysis will provide clarity on how 2020’s sweeping changes will affect your agency’s payments. Most importantly, your report will include recommendations to help your HHA successfully prepare for PDGM’s reimbursement impact.

PDGM Impact Analysis: Preparation Is Paramount

Your PDGM Impact Analysis provides an evaluation of:

• Overall Reimbursement Impact
• Therapy Visit Reimbursement Impact
• Full Payment & LUPA: PPS to PDGM
• Invalid Primary Diagnosis under PDGM
• Clinical Groupings & Top Ten Diagnosis Statistics
• Source of Admission & Episode Timing Statistics
• Functional Category Distribution Statistics
• Comorbidity Adjustment Distribution Statistics
• Recommended Preparations for PDGM

The analysis will include a comparison of Agency data to the average of all agencies in the State.

Let’s discuss how we can help prepare your agency for success under PDGM.

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Steps for Success

For a successful transition to PDGM, HHAs must develop a thorough understanding of how PDGM changes will affect reimbursement and clinical operations. Agencies should take the following actions to begin preparation for PDGM:

1. Ensure that whomever is finalizing your agency’s ICD-10-CM coding fully understands that the primary diagnosis needs to be specific enough to meet the code list requirements that group patients into Clinical Groupings & the significance of coding all comorbidities/secondary diagnoses that are pertinent to the patient’s care plan and will impact patient care and the Comorbidity adjustment when calculating a case mix grouping for PDGM.

2. Evaluate your current practice of providing therapy services. Determine how to provide therapy effectively for patient care and outcomes while containing costs. Consider utilizing therapy assistants, telehealth/remote monitoring, etc.

3. Evaluate your HHA’s current revenue cycle process. This will allow you to establish whether or not the agency will need to add staff or outsource billing to manage the increased billing volume.

4. Review Calculations of the impact of the PDGM model on the agency’s reimbursement overall.

5. Review Calculations of the cash flow impact for the first months of 2020 to establish if your agency will need to consider building cash reserves prior to the implementation of PDGM.

6. Review the agency’s Clinical Operations. Establish patient care plans, determine the frequency and duration of visits, and decide how to best reinforce the expectations of continued excellent patient care and outcomes under PDGM.

7. Evaluate the current level of LUPA episodes and how that will vary under PDGM.

PDGM Series: The 2020 Proposed Rule Update

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Are You Prepared? The Patient Driven Groupings Model (PDGM) Is Coming Soon

By Melinda A. Gaboury, CEO / Posted on: April 30, 2019

Home health agencies may find many of the changes to OASIS-D daunting, but there are several modifications that have helped make assessments easier than ever before. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) is the primary…

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Melinda A. Gaboury


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D. Mark Cannon, CPA


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Aaron D. Carey