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On January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will implement a new payment model that will replace the current Home Health (HH) Prospective Payment System (PPS) with the Patient-Driven Grouper Model (PDGM). This new model for Medicare Part A payment will be implemented for all HH agencies for episodes of care starting on/after January 1, 2020.
This new payment model will create both opportunities and challenges for nurses, therapists, suppliers, and HH administrators, including: more emphasis on diagnoses, coding of comorbidities, functional level coding, and managing the number and type of services delivered. Understanding these various components and how they interact with each other will be critical to the transition to PDGM. Our Chief Quality and Operations Officer, Lisa Chambers, hosted industry expert Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC for a free webinar to go over some key topics before PDGM begins.
- Describe the components of the Patient Driven Grouper Model (PDGM).
- Define the role of ICD-10 coding to the payment model.
- Understand the calculation of function and comorbidities and its impact on the clinical grouping.
- Develop action steps to prepare for the implementation of a change in payment to insure quality of care does not diminish.