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CMS Provides PDGM Tools & Resources

Posted on Monday, July 23, 2018 3:22 PM

By Sue Payne

CMS has updated and added some tools/resources agencies can utilize to understand the impact of PDGM on their organization. The tools can be found here.

The PDGM Grouper tool is similar to the one that CMS provided for HHGM, but they have updated it with the tweaks CMS has made to PDGM. As a reminder, this tool is good for one scenario at a time. For example, you could choose a common diagnosis/scenario that is common for your Medicare population and run it through the tool to compare revenue under PDGM versus revenue under PPS model.  This tool will not provide aggregate data so you cannot model your entire Medicare population using this tool. A help document is also available for use with the tool.

A new PDGM tool that CMS has provided is the PDGM Agency Level Impact. This tool provides Medicare revenue utilizing the current PPS model and then provides revenue utilizing the proposed PDGM model. This tool lists all agencies by CCN number. As a reminder since PDGM is now budget neutral, there will be agencies who look better under PDGM balanced with agencies who look worse under PDGM. It gives providers an overall view of what to expect with current population.

There are also files listing PDGM case weights and LUPA thresholds on this website.

CMS will also be providing along with CY 2019 proposed/final rule, an LDS (limited data set) of home health claims data for providers. When this becomes available, providers will have to request the limited data set. This data can then be utilized by providers to model/analyze operational and clinical impacts on their organization.


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