The Patient-Driven
Groupings Model

effective January 1, 2020


Implemented by the
Centers for Medicare & Medicaid Services

How will PDGM affect you and your patients' care?

PDGM requires primary diagnoses to include underlying cause(s) or to be more specific.

Meeting the more detailed diagnoses requirements from CMS will help ensure expedient initiation of care for your patients.


Number 1

Underlying Cause(s) example

Incomplete Diagnosis:
Muscle weakness

CMS-Acceptable Diagnosis:
Muscle weakness due to
acute exacerbation of heart failure

Number 2

Type Specificity example

Incomplete Diagnosis:
Fracture of clavicle

CMS-Acceptable Diagnosis:
Fracture of clavicle, right proximal

Electronic Medical Records ensure expedient initiation of care.

Enhanced clinical quality, patient satisfaction, and operational efficiency are just one click away.

Shared EMR Access

Near real-time data, including patient vitals, diagnosis, wound history and medications

The latest and most accurate answers for patient/family inquiries

Less time and space dedicated to office filing

Electronic signatures for home health orders, re-certifications, and face-to-face documentation

Identification of billing eligibility for time spent on Care Plan Oversight

HIPAA-compliant data handling

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