The Patient-Driven Groupings Model (PDGM) is the most significant change to the home health payment reform in the past two decades. The impact from PDGM is expected to significantly shift service delivery and will change the structure of home health reimbursements. Two key components for calculating payment under PDGM will be clinical group assignment and comorbidity adjustment, thus making ICD-10 coding more important than ever.
The need for specific diagnoses is not limited to the primary diagnosis section. PDGM introduces a co-morbidity adjustment that is calculated from up to 24 diagnoses that follow the primary reason home care is tracking the patient. The co-morbidity adjustment can increase reimbursement up to 20%.
Specificity and accuracy in ICD-10 will be critical. The long-held practice of accepting whatever patient information physicians deem to send agencies for referrals — because “that’s all they have,” will no longer be an option under PDGM.
Join the experts from BlackTree Healthcare Consulting as they take a deeper dive into the detail of PDGM clinical groupings and co-morbidity adjustments. This training will provide participants with a deeper understanding of the challenge’s agencies will face with these two key components in PDGM and how best to prepare for a smooth transition.
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- Define what a co-morbidity adjustment is under PDGM.
- Describe the changes to the regulatory language for coding secondary diagnoses under PDGM versus the Home Health Prospective Payment System.
- Understand when a Low, High, or No co-morbidity adjustment is applied.
- Discuss when secondary diagnosis would be used to determine the clinical grouping for primary diagnosis.
- Explain the steps to navigate the PDGM grouping tool, including how the clinical grouping and co-morbidity adjustment is calculated.
- Discuss operational strategies related to coding and the co-morbidity adjustment to support the transition to PDGM.
Robin N. Seidman, RN, MSN, MBA, LNCC, is Senior Director of Clinical Services for BlackTree Healthcare Consulting. She is a nursing leader with a career in health care spanning more than 25 years of progressive experience in management and consulting. Her extensive consulting background in home health and hospice includes over 18 years of providing expertise in: compliance, operations, due diligence and risk assessment, training, and quality and performance improvement. Robin has been successful in leading many large provider investigations and assisting legal counsel in negotiating settlement agreements. She has an excellent track record for assisting providers under government scrutiny to decrease potential overpayment risk by using her profound understanding of the industry regulations and documentation compliance requirements. Additionally, she has been an IRO for several post-acute providers under an OIG Corporate Integrity Agreement and is a certified Legal Nurse Consultant providing expert witness and opinions regarding home health and hospice standards of care and documentation compliance.
Registration & Fees
As a benefit of membership, HCAF Members receive 50% off the regular registration fee. To obtain the membership discount, please log in to your profile before registering. For registration assistance, to register by phone, or for more information, email us or call (850) 222-8967.
- HCAF Members: $29
- Associate Members: $29
- Private Duty Members: $58
- Prospective Members: $58
Participants will receive 1.0 continuing education unit for skilled nursing, occupational therapy, and speech therapy.