January 2, 2020
Home Health PDGM Billing Resources
The following self-service options have been developed to assist home health providers with billing requests for anticipated payments (RAPs) and final claims under the Home Health Patient-Driven Groupings Model (PDGM), with From dates of service on or after January 1, 2020.
- Home Health Patient-Driven Groupings Model (PDGM) 30-Day Period of Care Billing Schedule - The dates of service on your claim must reflect the 30-day period of care unless the patient transfers to another home health provider, is discharged, or dies. This resource will assist in determining the 30-day period From/Through dates.
- PDGM Admission Source 14 Day Calculator – This resource will calculate the 14 day period prior to the home health admission to assist with determining whether the admission source is institutional or community and if occurrence code 61 or 62 should be reported.
- Home Health Patient-Driven Groupings Model (PDGM) Final Claim Timeliness Calculator – Use this tool to prevent your RAP for periods of care that begin on or after January 1, 2020, from being auto-cancelled by FISS.
These resources can be accessed from the Home Health Patient-Driven Groupings Model (PDGM) Web page, and the Self-Service Options Web page.
Other PDGM Billing Resources
- Submitting a Request for Anticipated Payment (RAP) under the Home Health Patient-Driven Groupings Model
- Submitting a Final Claim under the Home Health Patient-Driven Groupings Model
Please review and share this information with your billing staff.