Software and Services for Home Health, Hospice and Healthcare Facilities
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Home Health PDGM


Act Now
We have added features and services not just to handle the mandate but to help you thrive under PDGM!

How HealthWare Can Help

  • Quick start analysis using your existing OASIS files
    • See projected changes in revenue comparing PPS vs PDGM
    • See non-quailifying primary diagnosis codes
    • Identify physicians referring patients with non-qualifying primary diagnosis codes
    • Costs as little as $500 and can be used until 1/1/2020
  • Software that understands PDGM in the Office and at the Point of Care
    • See projected HHRG and Reimbursement at the Point of Care and the Back Office
    • Instantly be warned of non-qualifying primary diagnosis codes during data entry
    • See what secondary diagnosis codes qualify for co-morbidity

What you need to know

It is estimated that 44 percent of home health agencies will experience a decrease in reimbursement with the new Patient Driven Groupings Model (PDGM) coming January 1, 2020. This is going to be the most significant change to home health payment reform since the transition from IPS to PPS nearly 20 years ago. Whether your agency is small or large, it’s important that providers start now on making the organizational changes that are going to be necessary in order to succeed with the transition from PPS to PDGM. From educating your referrals and clinical staff to discovering how technology can provide insights into your data. Just some of the steps you can be taking now to help you prepare. HealthWare is ready to assist you with what you’ll need to thrive under PDGM.

HealthWare is Ready for PDGM

  • Features like our PDGM Analysis Tools which can help identify what you need to do in 2019 to prepare for 1/1/2020.
  • We built our own PDGM Grouper allowing us to utilize it throughout HealthWare. Our analysis services use our grouper, billing uses our grouper and we have also integrated the grouper into HealthWare’s clinical features so that clinicians can preview the resource group and calculated payment. Using our unique PDGM Calculator you can quickly see how any changes in the diagnoses or functional level affect the payment.
  • We validate for qualifying primary diagnosis codes right from the start to make sure you are aware of any diagnosis codes that won’t qualify for billing under PDGM and we do that today so you can better become aware of what codes will have to be under PDGM. We can even help with coding diagnosis codes that will qualify under PDGM.
  • We show you co-morbidity qualifying diagnosis codes and if you have a high, low or no adjustment.
  • Features to support non-clinical staff collecting and entering information such as medications, diagnosis codes and more.
  • Features to support scribing which allows the nurse to go onsite while someone in the back office fills out the OASIS and other clinical forms.
  • Use our built in Clinical Assistant at the Point of Care and Back Office to do automated OASIS QA and other clinical validation. We also interface to several third-party OASIS scrubbing and analysis tools such as OperaCare and SHP.
  • We support entering primary diagnosis code plus 24 secondary diagnosis codes both in the back office and at the point of care.
  • We check for Low Utilization Payment Adjustments (LUPA) thresholds and alert you if one will be triggered by a change in a patient projected, scheduled and actual visits.

Assess How PDGM Will Affect You

Baseline benchmarking and analysis of how PDGM will affect your home health agency is the first step toward determining the impact this payment model could have based on your current patient care delivery process. At that point and with that knowledge, you’ll be able to begin making the organizational process changes needed to thrive under PDGM. HealthWare can help you get this information so you can start preparing now.

  • Quick start analysis using your existing OASIS files
  • See projected changes in revenue comparing PPS vs PDGM
  • See non-quailifying primary diagnosis codes
  • Identify physicians referring patients with non-qualifying primary diagnosis codes

The Good News!!

  • With proper preparation you can be ready for Home Health PDGM
  • HealthWare can help you prepare
  • We can combine our technical and analytical expertise with our partners to provide you even more resources

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