Understanding the PDGM Home Health Payment Model
The Patient-Driven Groupings Model (PDGM) is one of the most significant changes in home health care payment policies, initiated by the Centers for Medicare & Medicaid Services (CMS).
PDGM is designed to improve the accuracy of Medicare payments made to home health agencies (HHAs) by focusing on patient characteristics and treatment requirements instead of therapy minutes. Therefore, PDGM is challenging HHAs to rethink their processes and operations to deliver quality care while staying profitable.
PDGM and Revenue Cycle Management
PDGM requires that all medical billing in home healthcare is diagnosed with an ICD-10 code. So, HHAs need to be well prepared to handle this requirement to maintain their revenue and profits.
Here are some revenue cycle management strategies that can help HHAs navigate the challenges of PDGM effectively:
Maximizing Clinical Documentation:
Since PDGM is a patient-centered model that heavily relies on diagnosis and referral source, accurate and comprehensive clinical documentation is crucial. HHAs need to ensure documentation includes detailed patient information the physician’s order is signed and includes accurate ICD-10 codes and comorbidities to ensure the condition of the patient is reflected accurately.
Streamlining Billing and Coding Processes:
HHAs need to streamline their billing and coding processes to ensure submitting accurate and timely claims. This will ultimately help HHAs getting paid quickly, and avoiding delays, and will reduce the risk of non-payment.
The Importance of Data Analytics and Quality Measures
PDGM requires that HHAs implement adequate quality measures, which provides accurate insights into patient outcomes and compliance. Therefore, leveraging data analytics is essential for HHAs to track performance, improve care delivery, and maintain compliance.
Measuring Outcomes:
Capturing the patient outcomes is vital for the HHAs to ensure success with PDGM. Hence, HHAs should create an outcome measurement plan that monitors how well the agency is helping the patients meet their recovery goals and clinical improvement targets.
Continuous Quality Improvement:
HHAs need to have a process in place to continuously analyze performance data to make informed business decisions, identify areas of improvement, and develop strategies to improve operational efficiency.
Conclusion
Navigating the PDGM Home Health Payment Model requires a well-coordinated plan that involves rethinking processes and operations, and adopting revenue cycle management practices, leveraging data analytics, and implementing quality measures to ensure compliance and success. HHAs that adhere to these essential strategies will be in an excellent position to streamline their operations, maximize reimbursements, and improve patient outcomes.
