Under PDGM, timing and admission source may not reflect the amount of care needed

Effective Mar 27, 2019
Published Mar 27, 2019
Last Reviewed Mar 27, 2019
During claims processing under the Patient-Driven Groupings Model (PDGM), Medicare systems will pull information to automatically assign appropriate early or late timing and community or institutional admission categories to patients. Both variables factor substantially into payment methodology, with CMS paying higher rates for the first 30-day payment period and for patients coming from institutional sources.
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