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CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOMEPatientDriven Groupings Model Mini Conference October 2829, 2019 Ontario, CADoubleTree by Hilton 222 N. Vineyard Avenue Ontario, CA 91764 Phone: (909)

How to fill out patient-driven groupings model

How to fill out patient-driven groupings model

1. To fill out the patient-driven groupings model, follow these steps:
2. Obtain the necessary patient data, including the patient's diagnosis, functional impairment level, and comorbidities.
3. Determine the primary reason for the patient's therapy and classify it into one of the four PDGM clinical categories: musculoskeletal rehabilitation, neuro/stroke rehabilitation, wound care, or behavioral health care.
4. Ascertain the patient's timing and volume requirements for therapy visits based on the patient's needs and homebound status.
5. Assess the patient's functional impairment level using the OASIS assessment tool. This will determine the patient's Functional Impairment Level (FIL).
6. Identify any comorbidities that might affect the patient's therapy outcomes and categorize them accordingly.
7. Calculate the patient's Case-Mix Weight (CMW) by assigning corresponding points to the patient's diagnosis group, functional impairment level, and comorbidities.
8. Use the calculated CMW to determine the payment category, which will classify the patient into one of the six PDGM payment categories: musculoskeletal impairment, neuro/stroke impairment, wound care, behavioral health, complex nursing interventions, or medication management.
9. Complete the necessary documentation and submit the patient's information, CMW, and payment category to the appropriate authority for reimbursement.

Who needs patient-driven groupings model?

1. The patient-driven groupings model is primarily needed by healthcare providers, specifically home health agencies and therapists. It is used to determine accurate payment and reimbursement rates for therapy services provided to Medicare beneficiaries.
2. Additionally, patients who require home health therapy services can indirectly benefit from the patient-driven groupings model, as it helps ensure that their therapy needs are properly assessed, categorized, and accounted for in the payment system.

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What is patient-driven groupings model?

The Patient-Driven Groupings Model (PDGM) is a payment model for home health care services that focuses on patient characteristics and clinical needs rather than the volume of services provided.

Who is required to file patient-driven groupings model?

Home health agencies that provide care to Medicare beneficiaries are required to file under the Patient-Driven Groupings Model.

How to fill out patient-driven groupings model?

To fill out the Patient-Driven Groupings Model, agencies must collect patient data such as diagnosis, functional status, and service needs, and then use this information to assign the patient to a PDG group for billing purposes.

What is the purpose of patient-driven groupings model?

The purpose of the Patient-Driven Groupings Model is to improve the quality of care for patients by emphasizing patient-centered care and aligning payment with patient needs rather than service volume.

What information must be reported on patient-driven groupings model?

Agencies must report patient demographics, clinical data, functional status assessments, and care needs to accurately assign patients to PDG groups.