For home health organizations, referral and intake directly impact an agencies core operations and ability to provide appropriate care and bill in a timely manner. PDGM adds a new layer of complexity to this process by introducing the 30-day billing periods and admission source.

Home health organizations depend on their staff and tracking systems for a quick and efficient order management process. Order management is a key component within the revenue cycle process, as the collection of physician documentation is required to initiate any billing process. A bill cannot be generated without first obtaining all necessary orders.

In the 2020 Patient-Driven Groupings Model (PDGM) environment, LUPAs will become even more complicated with the introduction of the multifaceted structure of visit requirement variables. Like so many other aspects of PDGM, this change in calculation requires your attention.

The Patient-Driven Groupings Model (PDGM) is the most significant change to the home health payment reform in the past two decades.  The impact from PDGM is expected to significantly shift service delivery and will change the structure of home health reimbursements. A key component for calculating payment under PDGM...

The Patient-Driven Groupings Model (PDGM), is the most significant change to the home health payment reform in the past 20 years. PDGM completely alters the methodology for calculating payments, and an example of this is the removal of therapy utilization as a component and the payment periods have been reduced from 60 to 30-days...

The home care provider was experiencing a high LUPA rates that consistently exceeded 15%. A staffing shortage, particularly with nurses, combined with communication challenges throughout made it difficult to achieve positive patient outcomes.

More than any of the very complex modifications contained in the Patient-Driven Groupings Model, the most important enhancements emphasize the dire need for all agencies to have a solid and well-functioning episode management program in place before January 1, 2020.

The proposed home health groupings model (HHGM) has resurfaced in an updated form—the Patient-Driven Groupings Model (PDGM).