Home Health Patient-Driven Groupings Model (PDGM)
The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1689-FC) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019. Change Request 11081 implements the policies of the Patient-Driven Groupings Model (PDGM), effective with claim “From” dates on or after January 1, 2020. For more information, please refer to the following resources.
CGS Resources:
- CGS Overview: Home Health Patient-Driven Groupings Model (PDGM)
- Top Provider Questions – Home Health Patient-Driven Groupings Model (PDGM)
- Request for Anticipated Payment (RAP) Changes in Calendar Year 2021 Fact Sheet
- Submitting a Request for Anticipated Payment (RAP)
- Submitting a Final Claim
Self Service Options: - Home Health Patient-Driven Groupings Model (PDGM) 30-Day Period of Care Billing Calculator
- Home Health Patient-Driven Groupings Model (PDGM) Admission Source 14-Day Calculator
- Home Health Patient-Driven Groupings Model (PDGM) Final Claim Timeliness Calculator
- Home Health PDGM Timeline
- Home Health Low Utilization Payment Adjustment (LUPA) Threshold Calculator
CMS Resources:
- CMS CY 2020 Home Health Final Rule with Comment Period
- CMS Home Health Patient-Driven Groupings Model Web page
- CMS CY 2020 Interactive Grouper Tool
- CMS CY 2020 PDGM Case Mix Weights and LUPA Thresholds
- August 21, 2019, Home Health Patient-Driven Groupings Model: Operational Issues presentation
- February 12, 2019, Overview of the Patient-Driven Groupings Model (PDGM) presentation
- MM11577 – Manual Updates Related to Calendar Year (CY) 2020 Home Health Payment Policy Changes, Maintenance Therapy, and Remote Patient Monitoring
- MM11527 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Revised and Additional Manual Instructions
- MM11395 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Revised and Additional Manual Instructions
- MM11272 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions
- MM11081 – Home Health Patient-Driven Groupings Model (PDGM) – Split Implementation
- SE20005 – The Role of Therapy under the Home Health Patient-Driven Groupings Model (PDGM)
- SE19027 – Overview of the Patient-Driven Groupings Model
- SE19028 – Payments and Payment Adjustments under the Patient-Driven Groupings Model
- Home Health Agency (HHA) Center
Reviewed: 12.08.21