Pdgm explained. A successor of the proposed Home Health Groupings Model (HHGM), PDGM introduces new payment episode timings and removes Learn what PDGM means for home health administrators and how to optimize therapy services, documentation, and compliance for better Medicare reimbursement. Key component of determining payment in PDGM is the 30-day period clinical group assignment Each 30-day period will be grouped into one of 12 clinical groups based on the patient’s primary diagnosis The primary diagnosis provides information to describe the primary reason for which a patient is receiving home health services The PDGM Model includes a comorbidity adjustment based on the presence of a secondary diagnosis. Hello, I'm Sage, Palmetto GBA's digital chat assistant. . This is a payment model used in home health for Medicare Part A beneficiaries to cover home health services. There was concern about job losses, reduced pay, reduced work, layoffs, bankruptcies, and everything in between. The home health specific comorbidity list includes 13 broad categories with 116 subcategories. Oct 9, 2025 · Learn the essentials of PDGM (Patient-Driven Grouping Model), how it works, key drivers, strategies for optimization, and how to stay compliant—in a clear, actionable guide for home health agency owners. This shift represented a fundamental change in payment philosophy. The model is a case mix model that groups patients for payment purposes into categories based on certain patient characteristics. Timing of the 30-day period (two subgroups): early or late. To get started, please answer the questions below. This new model took effect on January 1, 2020. We answer the question "What is PDGM in home care?" In this Blog Post we answer what PDGM means for home health agencies, therapists, and reimbursement. Admission source (two subgroups): community or institutional admission source. The Patient-Driven Groupings Model (PDGM) is the biggest change for home health agencies in over two decades. The Ultimate Survival Guide to Transitioning to the Patient-Driven Groupings Model (PDGM) The Centers for Medicare & Medicaid Services (CMS) is overhauling the home health prospective payment system as they continue the shift toward value-based care. The planned implementation date is January 1, 2020. Additional fields may appear based on previous answers. Sep 3, 2025 · Learn how the Patient-Driven Groupings Model (PDGM) impacts home health agencies, why billing is complex, and how platforms like ShiftCare simplify compliance and maximize reimbursements. Why the change? The Bipartisan Budget Act of 2018 (BiBA) requires reform of the current payment model to address several perceived problems in the PPS home health […] Feb 12, 2019 · Patient-Driven Groupings Model (PDGM) The PDGM is a new payment model for the Home Health Prospective Payment System (HH PPS) that relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. As case mixes change, agencies will need to take measures to ensure that their staff’s competency meets the level of Dec 20, 2019 · The PDGM is a shift away from volume-driven home health payment to a model that focuses on the unique characteristics, needs, and goals of each patient. The billing cycle for home health agencies under PDGM will be for 30 day periods rather than 60 days. The Patient Driven Groupings Model (PDGM) — Overview The PDGM is a new payment model for Medicare certified home health agencies (HHAs). Jul 22, 2022 · What is PDGM? PDGM stands for the Patient-Driven Grouping Model. Fields with a red asterisk (*) are required. Case mix payment groups Under PDGM, Medicare pays home health agencies a predetermined amount for each 30-day period of care, adjusted based on patient characteristics rather than the volume of services provided. Figure 1 below provides an overview of how 30-day periods are categorized into 432 case-mix groups for the purposes of adjusting payment in the PDGM. After nearly a year, what are the results? What have we learned? What is it that we need to change? As one of the most significant updates to PPS since 2000, the CMS approach to the Patient-Driven Groupings Model (PDGM) focuses on providing a higher quality of care, keeping individuals in the best acuity setting possible and reducing unnecessary treatment and services. Jun 4, 2021 · What does PDGM mean for therapists? As PDGM was rolled out and explained, many were understandably concerned with therapy and PDGM. I can assist you with looking up your Medicare information. Clinical grouping (twelve subgroups): musculoskeletal rehabilitation; neuro/strokerehabilitation; wounds; Medication Management, Teaching, and Assessment (MMTA) Functional impairment level (three subgroups): low, medium, or high. May 13, 2021 · PDGM is daunting, but it doesn't mean the end for agencies. PDGM is part of the Home Health Prospective Payment System or HH PPS. Learn what PDGM is in home health, how the Patient-Driven Groupings Model affects Medicare reimbursement, and why documentation accuracy is critical for compliance. Axxess is the leading global technology platform for healthcare at home, providing a robust ecosystem that helps more than 9,000 organizations deliver the best quality care. The transition to the new model requires agencies to examine patient needs, comorbidities, and referral sources to determine if their case mix optimizes reimbursement. The Patient-Driven Groupings Model (PDGM) uses 30-day periods as a basis for payment. Mar 19, 2019 · The Patient-Driven Groupings Model (PDGM) is an alternative payment model that will replace the home health Prospective Payment System (PPS). drwj hrkqyfic dvxk szok beomy muez hbikn asnet nfsyqq uviadus