SHP is pleased to announce the release of a new feature to help home health agencies prepare for coding requirement changes with the January 1st, 2020 implementation of the Patient-Driven Groupings Model (PDGM).

Under the PDGM, primary diagnosis codes are now categorized as either “acceptable” or “unacceptable”, based on inclusion within PDGM clinical groupings. The latest CMS Grouper Tool indicates 43,223 acceptable codes. Using an “unacceptable” code as a primary diagnosis will lead to claim rejection.

Our new Unacceptable Diagnosis Alert will notify users whenever a primary diagnosis code is entered that Medicare deems unacceptable. This will help home health agencies start training their staff now to be ready for PDGM and avoid the delays and lost time associated with claim rejection and recoding. An example of this new informational alert can be seen below.