Axxess AgencyCore Spotlight: System Enhancements for PDGM Success


To succeed in the changing regulatory landscape, home health organizations must begin to adapt to the new Patient-Driven Groupings Model (PDGM), which takes effect January 1, 2020. Axxess is committed to helping our clients learn about this new reimbursement model and grow their business. Our in-house engineering team has released new features into our software that will help our clients prepare for, navigate and thrive under PDGM. These enhancements are just the first set we will release over the next few weeks.

PDGM Modeling Tool

We have created an interactive training tool that is designed to let users learn how different factors generate one of the 432 payment resource groupers. This modeling tool is not tied to any patient, so the data can be adjusted in several different ways. Our clinical product managers see this as a way to help agencies learn about PDGM and understand why they need to collect required information to be reimbursed for the care that is provided.

Revenue Impact Analysis

There are several different tools available from consultants and even the Centers for Medicare and Medicaid (CMS) that show an analysis of an agency's financial impact under PDGM. However, none of them provides the level of detail and accuracy as the analysis created by Axxess. This report is created using proprietary technology that gathers historical data over three years. The analysis from most tools only includes data from one year - 2017. There is a lot that has changed since 2017, which is why we wanted to create a resource that has more accurate information.

One of our clients reviewed the analysis from CMS and thought they would be okay under PDGM. When they ran this report using three years of data, they discovered they would earn $5 million less compared to the current payment system. Our Revenue Impact Analysis feature has shown them case management behaviors that need to change.

Case-Mix Analysis

Axxess' case-mix analysis is a way to drill down to the patient level and see how PDGM could change the reimbursement for the episode. Once the OASIS assessment is completed, users with the appropriate permissions in the software will see a side-by-side comparison. This will show the projected payment of caring for this patient. Users will also see whether caring for the same patient under PDGM would result in a higher, lower, or flat reimbursement rate.

This feature is tied to real patients, so the information can be used to learn about the new payment model's direct impact on operations.

Real-Time Alerts

Axxess software has always featured alerts to let users know important information. Our teams have created new alerts during the intake process that will help staff members know upfront if the diagnosis will be payable under PDGM. This is another way to train staff on the importance of having primary diagnoses codes that generate one of the 432 payment codes. Entering a questionable encounter code will not be payable. These alerts will let organizations decide at intake whether the patient is appropriate for home health.

The in-house engineering team at Axxess is working on many more enhancements that will help organizations thrive under PDGM. Additional information on these enhancements is available in our Help Center. Remember that Axxess has a PDGM resource center to help explain the new payment model with videos, frequently asked questions, blogs, and quick reference guides. We know this is a major change for home health organizations, so we are working together to build solutions that grow your business and make lives better.