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The PDGM is a shift away from volume-driven home health payment to a model that focuses on the unique characteristics, needs, and goals of each patient.

Medicare’s Patient-Driven Groupings Model is a patient-centered payment system that places home health periods of care into more meaningful payment categories while eliminating the use of therapy service thresholds for adjusting payment for home health episodes. The system also moves payment from a single 60-day episode to 30- day periods of care, still retaining the 60-day certification and plan of care requirements.

There are several myths about the PDGM. Claims that the need for therapy will be diminished, that only patients discharged from an institutional setting will receive therapy, that the PDGM doesn’t support maintenance therapy, and that services cannot be delivered after the first 30 days are false.

Similarly, rumors that therapy will be covered only when a patient is assigned a clinical grouping of musculoskeletal rehabilitation or neurological/stroke rehabilitation, that Medicare will dictate which providers are qualified to provide certain types of therapy, and that home health visits will be dictated by the Low Utilization Payment Adjustment (LUPA) claims system are all untrue.


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