We can sleep at night because our EHR prepares us for PDGM, ADRs and all other CMS requirements.

Paul Pisano, MSPT, GCS, COS-C, President & CEO, Interim HealthCare, Hartford County
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PDGM for home health

Preparing for success and beyond.

We’re here for you. And we want to make sure you’re equipped with the software and services you need to handle the biggest change in decades – including a whole new set of requirements that could put the squeeze on your productivity and profits.

What is PDGM? Patient-Driven Groupings Model (PDGM) is the new Home Health Groupings Model (HHGM) – which was the original iteration of this final rule.

A quick overview of significant changes:

  • The Payment Periods: 30-day periods instead of 60-day episodes
  • The LUPA Threshold: Unique LUPA thresholds from 2-6 visits for each of the 432 HIPPS codes
  • The Clinical Grouping: 12 Clinical Groups based on primary diagnosis code
  • The Comorbidity Coding: No, low or high comorbidity adjustment based on secondary diagnoses
  • The Timing: Early periods for first 30-day period only, anything beyond 30 days considered late
  • The Admission Source: Patients will be classified as either institutional or community based on 14-day look-back from the start date
  • The Billing: RAPs and final claims submitted every 30 days instead of every 60 days
  • Behavior Adjustments: CMS proposing behavior adjustment reducing payment by 6.42% based on expected behavior changes for LUPA utilization and coding.


Check out these resources to see how our automated software is the perfect tool to tackle PDGM’s shorter billing cycles, new LUPA thresholds and complex coding requirements.

Find out how MatrixCare can help you with your marketing, gain insight into referrals and ensure smooth transitions after intake.