With all the unknowns home health agencies have faced due to PDGM and COVID-19, one thing has been made clear and that is: times are changing. Although PDGM was mandated in the 2016 Cures Act, it wasn’t implemented until January 1, 2020. Yet, more reimbursement changes are slated for this upcoming January. So, to help organizations best prepare for these upcoming changes, we’re taking a closer look at how others have responded to PDGM and COVID-19 thus far and what best practices they recommend to stay financially fit.

Referral intake

The primary PDGM implementation issue for many agencies has to do with referral intake. Getting intake right is a tall order in a short amount of time. With many people working from home due to COVID-19, it’s harder than ever to reach referral sources. Furloughs and layoffs at a wide range of employers mean there’s a risk that any patient’s eligibility could change significantly. Not only that, but payers and coding requirements may also be changing in real time. Which means there is a lot to stay on top of from an operations standpoint. With the pending January 2021 PDGM changes, there will be an increased focus on the intake and admission process. Organizations will need to ensure timely workflows to avoid penalties. By leveraging a technology services partner, you can ensure that these common challenges are taken care of and accurately addressed.


Organizations have had to step up their documentation processes and ensure all their t’s are crossed and their i’s dotted. After all, incorrect documentation or the wrong diagnosis codes could impact a patient’s treatment and how you’re reimbursed. So, ensuring accurate charting and documentation could help prevent your organization from being in a financial frenzy. One challenge that makes it hard to ensure accuracy is tracking down patient health information. Having to hunt down information from a hospital or another provider can be time-consuming and tedious.

With staff inundated with administrative work, productivity can take a plunge. Not only that, but the focus on paperwork can leave patients paying the price. So, having a technology services partner that can work and integrate with your electronic health record (EHR) is key.

Order management

Order management has long been a concern in this industry and it’s where many focused when it came time to prepare for PDGM. A major issue in the home health care industry is a need to rely on partners that aren’t always aligned, resulting in a dependency that’s hard to control. To compensate, providers must continue to adhere to and own a strong process to keep everything moving in the right direction and on time.

For instance, who is the one person in your organization whom you seek out to get a follow-up status? That person must be predefined, and all team members should clearly understand their part of the process. And there must be a process. This is an area where a lot of organizations are still working out the details with PDGM. This can also be very tedious which is why many have turned to a technology services partner to do the follow-up work for them.

Claim management

The keys to success in claim management are frequency and follow-up. We recommend that organizations submit reimbursement claims as often as possible—daily if possible—to promote faster cash flow. Establishing a regular cadence of communication via email, Slack, a daily meeting, or a reports package helps keep teams accountable and aligned. New reporting requirements from PDGM make this level of communication more critical than ever. But we get that you don’t always have the time to chase down your claims to make sure you get paid. That’s why many have turned to a technology partner to do the busy work. A technology services partner, like HEALTHCAREfirst, can really help support your organization to focus on the people you serve, rather than the paperwork.

To recap

To conclude, PDGM and COVID-19 have changed how healthcare is being delivered. We’ve uncovered that the best way to navigate these changes is through a technology services partner that can support your staff’s workflow. In doing so, you can enable your staff to be efficient, proactive, and prepared for the unexpected.

The content in this presentation or materials is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. We encourage you to seek as appropriate, regulatory and legal advice on any of the matters covered in this presentation or materials.