Accuracy of Coding and OASIS Documentation Will Be Even More Important Under PDGM

Patient Driven Groupings Model

While we don’t know exactly what the final Patient Driven Groupings Model (PDGM) will look like, we do expect the proposed factors impacting the case mix weight adjustments to remain the same in the finalized PDGM. As you can see from this diagram, under PDGM, primary and secondary diagnosis codes will drive the clinical group assignment and the comorbidity adjustment. OASIS documentation will continue to drive the functional level scoring. Specificity and accuracy will be critical.

Additionally, because of the change to 30-day payment periods, turnaround time for coding and OASIS reviews will also be extremely important. If there was ever a time to explore Fazzi’s audits, outsourced coding and OASIS review services – the time is now! Learn where your agency stands and ensure you’re receiving appropriate and timely reimbursement while protecting your bottom line. We’re one of the largest and most experienced home health coding providers and our experts have been studying PDGM since its inception.

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