Solution Sheets

Sustain Financial Health Under PDGM

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Sustain Financial Health Under the Patient - Driven Groupings Model (PDGM) Tracking Claim Requirements As PDGM adds complexity to regulatory requirements, streamlining case management will become more difficult. With PointClickCare's Claim Console, case managers can track all billing requirements throughout an episode in one central location. With links to the patient chart to complete each task, it's easy to jump into the chart to complete outstanding items and check them off the list. The biller sees an indicator when all requirements are fulfilled, so they know exactly when the claim can be submitted. Without wasted time playing catch up for missing items, billers get final claims out the door for quicker reimbursement. LUPA Management Under PDGM, each 30-day period is subject to its own LUPA threshold, which means agencies will need to keep a close eye on LUPAs, especially in the second 30-day period. Each clinical grouping has its own LUPA threshold as well. As part of the grouping assignment, PointClickCare will identify and track the LUPA threshold and completion of visits against the LUPA count. PointClickCare will also help agencies monitor the overall percentage of LUPA episodes. Streamline your path to revenue and reduce days to bill with efficient billing of two RAPs and Finals for each 60-day episode of care. Improve communication and collaboration with dashboards that reduce back-and-forth pre-billing requirement communication. Reduce days sales outstanding with automated workflows for monitoring requirements, generating and submitting claims, and entering cash receipts. Improve compliance and reduce returned claims with automated validation of payer requirements. Monitor LUPA % and track LUPA thresholds per clinical grouping and 30-day billing period. In January of 2020, CMS requires compliance with its new Patient-Driven Grouping Model (PDGM) standard. Among other things, this standard introduces two 30-day billing periods per episode of care. With PointClickCare, you can be confident your financial management solution will make a seamless transition to compliance.

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