What is PDGM?

The Centers for Medicare & Medicaid Services (CMS) announced a new home health payment reform plan effective January 1, 2020 that replaces a volume-based payment model with a value-based payment system.   

This model will focus on patient needs and rely more heavily on patient characteristics to pay for home health services.

How is Careficient ready for PDGM?

  • EXPANSIVE PHYSICIAN ORDERS
    Accommodate an unlimited number of secondary diagnosis codes, key for documenting comorbities.
  • 30 DAY PAMENT EPISODES
    Careficient accommodates billing for 2 RAPs and 2 Final Claims per episode.
  • LUPA THRESHOLDS
    LUPA logic changes in place, automatically calculate when patients fall under a LUPA based on HHRG and Clinical Groupings.
  • REIMBURSEMENT
    Careficient accepts ERA from all MACs and easily posts them to patient invoices.
  • OASIS SUBMISSION AND VALIDATION
    All necessary forms are fully integrated with the system and are automatically generated and sent to the state for you.
  • PDGM ANALYZER
    Built in analyzer shows PDGM financial impact, projected reimbursements, and clinical groupings.
  • OASIS SUBMISSION AND VALIDATION
    All necessary forms including OASIS – D updates are fully integrated with the system and are automatically generated and sent to the state for you.
  • INTEGRATED ELIGIBILITY VERIFICATION
    Careficient verification fits seamlessly into your workflow process and automatically re-verifies for active patients.
  • DASHBOARDS / WHITE BOARD
    Have all of your agency’s performance metric in key areas available fright from one screen, including Financials, Census, Discharge, and Associate reporting.

Careficient Home Screen

Careficient Orders tab

PDGM Analysis

PDGM Account Receiveables

Want to learn more on how Careficient can help with PDGM?

We're here to answer any questions you may have. Feel free to call us at (866) 611-4597 or click Contact Us: