The implementation date for the Home Health Patient-Driven Groupings Model (PDGM) is on or after January 1, 2020. PDGM is an alternative case-mix methodology designed to put the focus on patient needs rather than volume of care. It relies heavily on patient characteristics to more accurately pay for home health services and uses 30-day periods as a basis for payment. These 30-day periods are grouped into 432 home health resource groups (HHRGs) based on admission source and timing, clinical grouping, functional impairment level, and comorbidity adjustment.

PDGM will dramatically impact the way that home health agencies operate. While some agencies may see an increase in payments, some will not. Either way, don’t delay in your preparations! Here are some resources to help.


Patient-Driven Groupings Model (PDGM) Resources

Written and Online Resources

PDGM Impact Tool

PDGM Handbook: Preparation from A to Z

Intake & Clinical Preparation Tips

Coding & Billing Preparation Tips

Agency Preparation Tips for PDGM

CMS Home Health Agency Center

CMS Overview

Case Mix Weights, LUPA Thresholds, and Agency-Level Impacts

CY2019 Home Health Final Rule

Interactive Grouper Tool

Split Implementation MLN Matters Article

Change Request 11272

Online Events

ABCs of PDGM: What it Means to Home Health & How You Should Prepare

Overview of the Patient-Driven Groupings Model National Provider Call Presentation

Overview of the Patient-Driven Groupings Model National Provider Call Transcript

Under PDGM, it will become increasingly more challenging to manage a successful home health business that still focuses on patient care. As these responsibilities continue to become more complex, you should be looking for third-party revenue cycle management services vendors who can alleviate some of these administrative burdens so you can continue to focus on your mission of providing quality, patient-centered care. Learn how HEALTHCAREfirst can get your home health agency ready for PDGM with our comprehensive clinical documentation review, coding, and billing services.

This resource hub is for informational purposes only and is not intended to be, and should not be construed as, legal advice. HEALTHCAREfirst strongly recommends that each agency consult with counsel of its own choosing for legal advice in this matter.