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Start preparing TODAY to guarantee your agency's success in the future. With ~6 months to go, ask yourself: Are you on track for the transition to PDGM? Do you have the right therapy partner?

HealthPRO Heritage at Home has compiled the following PDGM Preparation Checklist that can help organize a plan of action for home health agencies affected by the future of PDGM:

It can be easy to get lost in the details of PDGM and forget how vital outcomes and ratings are in driving overall agency success.  It’s one of the biggest reasons why appropriately managing therapy in PDGM is a key competency.

In HealthPRO Heritage at Home's recent survey with the National Association for Home Care and Hospice regarding therapy in PDGM, 48% of respondents anticipate less therapy utilization. Agencies should be cautioned on cutting therapy utilization given the focus on functional assessment and outcomes.  Functional assessments - completed best by a skilled therapist - will contribute significantly to payment in PDGM, while also continuing to drive publicly reported outcome measures and star ratings.

HealthPRO Heritage at Home partnered with the National Association for Home Care and Hospice (NAHC) to conduct a survey of home health providers to gather industry feedback on therapy utilization under PDGM. HealthPRO Heritage co-sponsored the survey as part of its ongoing effort to bring strategies and solutions to agencies as they prepare for PDGM. Nearly 700 people took the survey and were made up of representatives in every state from freestanding, institutional, health system and government based agencies from both for and not-for profit settings. 

The Patient-Driven Groupings Model (PDGM) is a game changer, requiring home health providers to explore new business models based on the introduction of new risks and potentially significant financial impacts.

HealthPRO Heritage at Home is leading the industry in readiness for the January 1, 2020 change to the Patient-Driven Groupings Model (PDGM). Success for both our partner agencies and employees will be driven through knowledge and implementation of process and strategy around PDGM.

Coding will be instrumental to your agency’s success under PDGM. Performing an audit of your coding practices now will provide the opportunity to educate your staff on accurate and cohesive coding guidelines and targeted aspects of the OASIS to ensure you are prioritizing both patient needs and accurate reimbursement. 

Accurate OASIS coding has always been important, but with PDGM on the horizon, our ability to master the OASIS will be imperative! After all, accurate OASIS coding will directly impact an agency’s ability to achieve optimal outcomes and support reimbursement in today’s and tomorrow’s world.

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.

PDGM implementation is a mere 38 weeks away, bringing significant changes in episode length (60 to 30 days), resultant billing processes, revenue cycle, and ultimately, cash flow. While certification periods will continue to be 60 days in duration, reimbursement will be broken into 30-day payment periods. As such, billing will have to be processed for each 30-day payment period including Requests for Anticipated Payment (RAPs) and final claims. This will likely result in a substantial increase in claims volume in addition to an interruption in cash flow. Specifically, agencies will experience a cash flow “crunch” during the first few months of implementation as the conversion from 60-day to 30-day payments is realized with a leveling off after the initial impact and conversion.

PDGM implementation is a mere 42 weeks away and is anticipated to be the biggest change in home health payment reform in over 20 years. HHAs will need to completely revise care management and billing processes, as well as documentation and coding practices, in order to make the transition successfully. One of the most dramatic areas of change relates to ICD-10 coding, which is a significant determinant of revenue in the new paradigm. Both timing and accuracy of ICD-10 Coding (primary diagnosis and comorbidities) will play a role in how patients are grouped and, ultimately, reimbursed. Given that this is a completely new core competency for HHAs, it is prudent to take action today to assess related risk and begin to identify the changes that will need to occur in order to minimize transition risk.