Home Health Grouper Software
Signing Up for Beta Testing
Each update of the Home Health Grouper software will be available for beta testing approximately 8-10 weeks prior to the implementation date. To sign up to beta test the Home Health October v01.2.20 Software release, please email firstname.lastname@example.org with contact information. The beta test period is from June 29 through July 17, 2020. Once email has been received you will be contacted with additional information on how to obtain the software package.
Home Health PDGM Grouper Software Package (for claims starting 01-01-2020)
UPDATE: Implementation of New International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes, Effective April 1, 2020:
In November 2018, CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The PDGM relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDGM, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.
There are two ICD-10 CM diagnosis codes recently implemented by the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) effective April 1, 2020:
- In response to the national emergency that was declared concerning the COVID-19 outbreak, NCHS is implementing a new diagnosis code, U07.1, COVID-19, into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and;
- In response to recent occurrences of vaping related disorders, the NCHS is implementing a new diagnosis code, U07.0, Vaping-related disorder, into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting vaping-related disorder.
Both U07.1, COVID-19 and U07.0, Vaping-related disorder will be assigned to the Medication Management, Teaching and Assessment-Respiratory (MMTA-Respiratory) clinical group for purposes of case-mix adjustment under the HH PPS. Additionally, U07.1, COVID-19, will be added to a new comorbidity subgroup, Respiratory 10, and will receive the Low Comorbidity adjustment under the HH PPS case-mix system. The clinical group assignment for U07.1, COVID-19, and Vaping-related Disorder, U07.0, and the Low Comorbidity adjustment for COVID-19, U07.1 will be included in the Home Health Patient-Driven Groupings Model (HH PDGM) Grouper software package, v01.1.20.The Home Health Patient-Driven Groupings Model (HH PDGM) Grouper software package, v01.1.20 is available for download. It is effective for home health claims with From Dates on or after April 1, 2020.
Included in the v01.1.20 software update are:
- Updated software to include the FY 2020 ICD-10-CM diagnosis codes effective 04/01/2020:
- U07.0 Vaping-related disorder
- U07.1 COVID-19
- Added one new Diagnosis Subchapter, Provisional assignment of new
diseases of uncertain etiology or emergency use (U00 – U49)
- Added new Comorbidity Subgroup Respiratory 10 which is flagged for low comorbidity adjustment
- HH PDGM grouping software package, version 01.1.20, in the zipped file named “HHPDGM.V01.1.20.Software.P”.
- HH PDGM Installation and User Manual is available in the ‘docs’ folder, once the software file is unzipped.
Support for the HH-PPS Grouper Software
For related questions, please use the following contacts:
- Email: HHGrouperQuestions@cms.hhs.gov: Contact for questions with HH PPS Grouper
Note: Please do not submit Protected Health Information through this email system. It is not necessary to send personally identifiable data to demonstrate your question or concern.
Home Health PPS Grouper Software Package (for claims through 12-31-2019)
Archived versions of the Home Health Prospective Payment System (HH PPS) Grouper are available for download. The HH PPS Grouper software will only work for OASIS submissions with an assessment completion date from through December 31, 2019. Effective January 1, 2020 the Home Health Patient Driven Grouping Model will be used to process Home Health claims.