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TIMING 30-DAY PERIODS; 432 CASE-MIX GROUPS; OASIS,ETC
Hello, I am reading week 2 Study Guide, and very, very confused about Admission Source;
Timing of the 30 Day Period; Clinical Groups: OASIS, I do not remember that Petria explained anything to us, so I am not sure how to understand Late 30-day periods and other stuff, like 432 case-mix groups, r we going to study this later?? because I do not see under introduction any information that we will study this. As I explained previously, I am COMPLETELY NEW to this, and I am not able to read and understand without someone to explain in details what it means. Would u please let me know how it works, is there additional information that I should read and it will explain more to me??? Thank u, Renata
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2 Replies
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You can go online and read information about PDGM. Patient Driven Grouper Models.
In Jan of 2020, CMS changed the way payments are made to home health. Previously it was 60 day episode, now it pays in 30 day episodes. The episode of CARE is still 60 days but in that time frame there will be 2 30- day billing cycles. So a plan of care will have 60 days, but you will bill in 30 day increments.
The 432 grouper models is basically the HHRG that the OASIS gives you. A certain set of dx, plus how you answer the MO questions will give you a certain HHRG, which equals your payment. The 432 means there are 432 different HHRGs possible.
Admission source is basically where your patient came from. There is institutional and community. Community is just that, like an MD office. Institution is from the hospital, etc. This can also affect the type of payment you receive.
I am not a teacher in this class, so you should reach out to Petria or someone else, however I have been in home health 20 years. You can find some PDGM resources online which is the new billing/payment system
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Hi Renata, yes we will cover this more in detail throughout this course.