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Get Ready for PDGM

Implementation of the new case-mix classification model, the Patient Driven Grouping Model (PDGM), on January 1, 2020 will bring BIG changes to the home health profession! HealthPRO Heritage at Home is ready to help you start preparing TODAY for the most dramatic Medicare reimbursement change since PPS.

To help accelerate our customers’ readiness for PDGM, we’ve already taken the steps below to add value in key strategic areas that will enhance our partnerships. 

Understand the Big Picture

  • HealthPRO Heritage at Home offers support and help to agencies with the analysis of their CMS PDGM Impact File
  • Fosters collaborative work plan development
  • Enables changes in areas that positively impact performance today and under PDGM
  • Assists agencies in identifying niche opportunities & accompanying therapy competencies
  • For agency partners, we leverage Advisory Board Analytics to gauge current market position & opportunity paving the way for best practices, better outcomes, and ultimately stronger margins
  • Though our calendar of PDGM focused Educational topics, we provide a defined customer and staff PDGM readiness plan

Revenue Cycle Matters

  • Our partnership commitment extends to the implementation of the Advanced OASIS Certification of all our Rehabilitation Directors and Regional Staff as Certified OASIS Quality Specialists (COQS):
  • Specialized OASIS expertise supports documentation accuracy and PDGM-enabled workflow for agency partners
  • Our COQS leaders conduct all field staff training, ensuring an advanced practitioner field model
  • Our staff OASIS Certified Nurse offers advanced pre-transmission review of OASIS assessments, contributing to effective agency revenue cycle
  • Using our customer exclusive Outcomes Based Quality Improvement (OBQI) Tool, our therapists complete a functional assessment at time of patient evaluation and discharge.  Therapists rate the Functional M items of the OASIS to ensure a collaborative approach OASIS scoring.
  • HealthPRO Heritage at Home is conducting ICD-10 staff education to support coding accuracy & optimize clinical grouping placement
  • We have revised our operational processes for clinicians to accelerate completion and submission of documentation in light of PDGM’s rapid billing cycle requirements (30-day payment period). This includes SOC OASIS documentation completion within 24 hours of the visit allowing the 5 day submission requirement to be met.

Case Management is King

  • HealthPRO Heritage at Home is developing evidence based, PDGM mapped clinical “Pathways to Success
  • Supports appropriate treatment care planning and utilization management in the absence of HHRG delivery guidance
  • Helps minimize risk of LUPAs through advanced care management
  • Offers compliance protection to minimize risk of retrospective audits
  • Always forward looking, we are reviewing various technological approaches to increase patient engagement, health literacy & self-care monitoring while minimizing costs
  • Our EMR , Therapy Sync, is fully prepared for PDGM including an up-to-date OASIS-D with GG items

Aligning Incentives Makes All the Difference
In addition to these proactive changes, HealthPRO Heritage at Home is leading the way by developing new contracting models to assist agencies in optimally managing therapy cost in an efficient manner  while still delivering quality care and achieving exceptional outcomes  under PDGM. 

To learn more, watch our previous webinar "The Countdown to PDGM is On! What Your Agency Can Do Now to Prepare" or contact us at homehealth@healthpro-heritage.com to learn how we can help you prepare for the most dramatic Medicare reimbursement change since PPS.

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Tags: Home Health, PDGM, CMS Update 2019, Revenue, OASIS