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

by  Wyn Staheli, Director of Research
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 https://www.findacode.com/articles/new-medicare-home-health-care-payment-grouper-are-you-ready-35850.html

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