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12 Μαΐ 2021 · NAHC defines it as “Case Mix—term used to identify resource use for Medicare providers. For Medicare home health, certain M items indicate clinical severity, functional status and service utilization and determine the case mix score.” You can access the link to that definition (here).
One case-mix variable is the assignment of the principal diagnosis to one of 12 clinical groups to explain the primary reason for home health services. 30-day periods are categorized into 432 case-mix groups for the purposes of adjusting payment under the PDGM.
Under the PDGM, each 30-day period is grouped into one of twelve clinical groups based on the patient’s principal diagnosis. The reported principal diagnosis provides information to describe the primary reason for which patients are receiving home health services under the Medicare home health benefit.
Each 30-day period is assigned a Home Health Resource Group based on five case-mix variables: 1. Admission source 2. Timing 3. Clinical Grouping 4. Functional Impairment Level 5. Comorbidity Adjustment 9
12 Φεβ 2019 · Current Home Health Prospective Payment System (HH PPS) • Implemented in October 2000 ‒Bundled payment for all covered HH services provided in a 60- day episode • Level of payment determined by case-mix adjustment ‒Allows different payment for patients with different needs
Outline the ICD-10 Coding & OASIS ADL Section Impact on the Home Health Resource Group (HHRG) under PDGM. Describe how interdisciplinary care planning can manage cost effective and appropriate skill mix, including therapy utilization.
The Patient-Driven Groupings Model (PDGM) is the biggest change for home health agencies in over two decades. The transition to the new model requires agencies to examine patient needs, comorbidities, and referral sources to determine if their case mix optimizes reimbursement.
