New Medicare Home Health Care Payment Grouper — Are You Ready?

by  Wyn Staheli, Director of Content
November 25th, 2019

Home Health’s biggest change in two decades begins January 1, 2020 when CMS will begin using a new Patient-Driven Groupings Model (PDGM) for home health payments. This new system has several key factors:

Case-Mix Adjusted Payment Group: The following variables are used to calculate the patient’s case-mix adjusted payment group: 

  1. Locationgeographic location where patient care is provided
  2. Admission Source institutional (acute or post-acute care provided within 14 days prior to admission) or community (no acute or post-acute care)
  3. Timingearly (first 30-day period of care) or late (subsequent 30-day period[s])
  4. Clinical Grouping: based on the primary diagnosis
  5. Functional Impairment Level: from OASIS items
  6. Comorbidity Adjustment: based on the secondary diagnoses

Like the RVU for outpatient services, the weight computed by the case-mix is multiplied by a factor (think conversion factor for RVUs) to arrive at an estimated monthly payment.

Medicare Home Health Payment Calculator for 2020

If this sounds complicated, well, it can be. To help home health agencies make this transition, Find-A-Code has a PDGM payment calculator for home health coming soon. All you need to do is fill out the simplified form with the applicable patient information and click the [submit] button. It’s easy, fast, and accurate.

New Medicare Home Health Care Payment Grouper — Are You Ready?. (2019, November 25). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (8-5 Mountain)
free demo
request yours today
free subscription
for any budget

Thank you for choosing Find-A-Code, please Sign In to remove ads.