Billing • Regulated by CMS
Patient-Driven Groupings Model (PDGM)
Definition: The Medicare home health payment model that calculates 30-day period reimbursements based on patient clinical characteristics rather than therapy visit volume.
Regulatory Impact & Compliance Overview
Effective January 2020, PDGM categorizes patients into 432 payment groups based on admission source, timing, clinical grouping, functional impairment level, and comorbidity adjustments.
Governing Authority
Enforced by CMS in United States. Compliance with these standards is legally required for all licensed and participating care providers.
Automated Compliance
How AsanWork Enforces Patient-Driven Groupings Model (PDGM)
AsanWork builds compliance directly into daily scheduling workflows. Hard compliance stops prevent un-vetted, un-screened, or non-credentialed staff from receiving shift allocations, ensuring 100% audit readiness.
Related United States Healthcare Terms
Regulation
21st Century Cures Act
A landmark federal healthcare law passed in 2016 designed to accelerate medical innovation, prevent health data blocking, and mandate Electronic Visit Verification for Medicaid home care.
Payroll
Blended Regular Rate (Overtime)
The weighted average hourly rate used to calculate FLSA overtime when a caregiver works at two or more different pay rates in the same workweek.
Regulation
CMS Conditions of Participation (CoPs)
Federal health and safety requirements that home health agencies and healthcare organizations must meet to begin and continue participating in Medicare and Medicaid programs.
Payroll
California Daily Overtime
A California state labor law requiring overtime pay of 1.5x regular pay for hours worked beyond 8 in a single day, and double pay for hours past 12.