What is PDGM?
Patient Driven Groupings Model (or PDGM), is a new home health reimbursement model under Medicare—the first major overhaul of the home health payment system since 2000. It is slated to begin January 1, 2020.
It requires shorter timetables for physicians orders and signatures and more specific primary diagnoses.
Codes such as weakness, debility, abnormal gait and fatigue will no longer be valid by themselves. Physician documentation must include the underlying cause of these conditions. In addition, symptom codes (R codes under ICD-10) and many unspecified codes will not be considered valid under this new reimbursement model if the underlying cause isn’t documented.
Please be as specific as possible about the primary patient issue leading to a referral to home health. As always, we will work with you and your team to identify acceptable documentation under this new reimbursement model.
The VNH Intake Team is here to help make the referral process go smoothly. If you have questions, please contact us at 800-575-5162.