● A partial episode payment (PEP) adjustment is made when a patient elects to transfer to another HHA or is discharged and readmitted to the same HHA during the 60-day episode.
What is PDGM home health?
The Patient-Driven Groupings Model (PDGM) is the biggest change for home health agencies in over two decades. The transition to the new model requires agencies to examine patient needs, comorbidities, and referral sources to determine if their case mix optimizes reimbursement.
What is prospective payment system in healthcare?
A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).
How do the prospective payment systems impact operations?
The prospective payment system rewards proactive and preventive care. ... The prospective payment system stresses team-based care and may pay for coordination of care. These value-based care models promote doctors, hospitals, and other providers to work together to receive value-based reimbursements from CMS.Jul 22, 2020