Managed Care/Per Visit PDGM Toggle

The Managed Care/Per Visit PDGM toggle gathers HIPPS and diagnosis codes from assessments based on CMS’s PDGM guidelines.

To access the PDGM toggle, navigate to the Insurances/Payers List and add or edit a per visit payer.

View tab ➜ Lists➜ Insurance/Payers➜ Add/Edit a Per Visit Payer ➜ Edit Line of Business

Scroll until you see an option to Check here is the Per Visit payer follows PDGM billing requirements.

To enable the feature, check the box and enter an effective date based on the payer’s implementation date of PDGM.

Claim start dates are used to determine if per visit claims are treated as first or second 30-day claims when collecting assessment information.

Updated on 1/12/2020