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CMS Manual SystemDepartment of Health & Human Services (HHS)Pub 10004 Medicare Claims ProcessingCenters for Medicare & Medicaid Services (CMS)Transmittal 4244Date: February 15, 2019Change Request

How to fill out home health patient-driven groupings

How to fill out home health patient-driven groupings

1. To fill out home health patient-driven groupings, follow these steps:
2. Gather all necessary information about the patient, including demographic data, medical history, current medications, and the reason for the home health care.
3. Assess the patient's functional abilities and determine their level of impairment in various domains such as mobility, self-care, and cognitive function.
4. Assign the patient to one of the six patient-driven groupings (PDGM) based on their clinical characteristics and functional status.
5. Determine the appropriate primary reason for home health care, which can be one of the following: musculoskeletal rehabilitation, neuro/rehab, wound care, behavioral health, complex nursing interventions, or medication management/teaching.
6. Document the patient's comorbidities, including any secondary diagnoses that may impact the care plan and payment classification.
7. Complete the appropriate OASIS assessment to capture additional data about the patient's health status and care needs.
8. Review and verify all the information entered, ensuring its accuracy and completeness.
9. Submit the patient-driven groupings payment claim to the appropriate payer for reimbursement.

Who needs home health patient-driven groupings?

1. Home health patient-driven groupings (PDGM) are needed for healthcare providers, such as home health agencies, who offer home-based medical services to patients.
2. These groupings help in determining the payment classification and reimbursement for the home health services provided.
3. PDGM is specifically designed for Medicare patients receiving skilled home health services on a part-time or intermittent basis.
4. It helps to ensure appropriate payment based on the patient's characteristics, care needs, and the services provided by the home health agency.
5. Other payers and insurers may also adopt similar patient-driven groupings models to ensure accurate payment and reimbursement for home health care services.

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What is home health patient-driven groupings?

Home Health Patient-Driven Groupings (PDGM) is the new payment model for home health services that is based on patient characteristics and care needs.

Who is required to file home health patient-driven groupings?

Home health agencies are required to file home health patient-driven groupings.

How to fill out home health patient-driven groupings?

Home health patient-driven groupings can be filled out using specific assessment tools and documentation to accurately capture patient information.

What is the purpose of home health patient-driven groupings?

The purpose of home health patient-driven groupings is to better align payment with patient needs and improve the quality of care provided.

What information must be reported on home health patient-driven groupings?

Information such as patient demographics, health conditions, functional status, and service utilization must be reported on home health patient-driven groupings.