The Patient-Driven Groupings Model (PDGM) is a Medicare payment system that categorizes home health care into payment groups based on patient information.
Home Health Patient-Driven Groupings Model:- The PDGM uses 30-day periods as the basis for payment.
- The PDGM categorizes 30-day periods into 432 case-mix groups.
- The PDGM uses clinical characteristics and other patient information to categorize periods of care.
- The PDGM focuses on the needs, goals, and unique characteristics of each patient.
- The PDGM eliminates the use of therapy service thresholds.
- Admission source: Community or Institutional admission source.
- Timing of the 30-day period: Early or Late.
- Clinical grouping: Musculoskeletal rehabilitation, Neuro/Stroke Rehabilitation, Wounds, and More.
- Comorbidity adjustment: None, Low, or High based on Secondary diagnoses.
In Billiyo the Information is driven by the way a Clinical Staff member Answers the Questions in the OASIS Assessment.
This Information is Driven to the Back Office Patient Dashboard, PDGM Tab where you can see Prospective Payment and also make Edits to the PDGM here.
If Making Edits, Please remember to Click Save.
To ADD a Diagnosis, Click the Plus Sign and a New Row will appear to enter the Data.
To Delete a Secondary Diagnosis Click on the Red Trash Can.
Don't forget to Save on the Edits that you have made.
For More Information on the Patient Dashboard, Please visit our Page: Patient Dashboard
In the Clinical Application, Nurses and Therapists Completing OASIS Assessments can Easily Identify the Questions that will affect PDGM.
These Questions will have Green Text.
