Recognizing that many Home Health Agencies have limited time and resources to prepare for PDGM, VantagePoint has focused scalable PDGM preparation services on the essentials. Our project leaders are consultants with experience and current certification in home health coding disciplines.

Home Health Agencies have a lot to do before the transition to the CMS Home Health Patient Driven Groupings Model (PDGM) effective January 1, 2020. Under the new rules, imprecise or incorrect coding of a primary diagnosis and missing or inaccurate secondary diagnoses can result in returned claims and lower reimbursements due to missing out on comorbidity adjustments. Agencies must undertake effective preparation actions to avoid the most immediate anticipated revenue and cash flow impacts of the transition. These actions should include analyzing the current state of ICD-10-CM coding accuracy, confirming the mapping of top utilized codes to PDGM groupings, and improving existing internal diagnosis coding expertise through training.

Our Services Include: 

  • Flexible remote or onsite project plans, including review of paper-based or electronic records

  • Claims data analysis to map primary diagnosis codes with applicable PDGM clinical groupings

  • Probe-level record reviews to assess primary and comorbidity coding accuracy, specificity, and training needs

  • Identification of opportunities to capture the PDGM comorbidity adjustment factor through proper coding and documentation

  • Group and individual ICD-10-CM training specific to Home Health billing requirements

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