How does EMRxAI reduce home health documentation time?

EMRxAI drafts visit notes and OASIS assessments from visit data automatically, with real-time QA validating CMS compliance and cross-document consistency as the clinician documents. Start of care takes about 16 minutes and routine visits about 7 - including the QA pass - instead of 2-3 hours charting at night.

How does EMRxAI prevent claim denials?

Every claim is scrubbed against the full clinical chart before submission. Documentation inconsistencies, missing face-to-face requirements, and PDGM coding mismatches are caught and fixed before the claim goes out - so denials are prevented rather than appealed.

Does EMRxAI handle NOA submission deadlines?

Yes. EMRxAI tracks the five-calendar-day NOA submission deadline from the start-of-care date on every admission and helps ensure the one-time Notice of Admission is accepted on time, avoiding the per-day payment penalties that come with late submission.

How does EMRxAI protect Medicare Star Ratings and survey readiness?

Real-time QA validates every document against the full chart and CMS rules as it is written, eliminating internal contradictions and deficiencies. The result is consistent, defensible, survey-ready documentation that protects Star Ratings and referral relationships.

Can EMRxAI help prevent LUPA revenue losses?

Yes. EMRxAI monitors visit counts against each PDGM payment group's LUPA threshold during the 30-day period and alerts the agency before a full episode payment drops to per-visit rates.

PDGM Guide

PDGM Explained: How Medicare Pays Home Health Agencies

8 min readUpdated July 20, 2026

The Patient-Driven Groupings Model (PDGM) has governed Medicare home health payment since January 1, 2020. It replaced therapy-driven payment with a clinically driven model built on 30-day periods and 432 case-mix groups. Understanding exactly how PDGM assigns payment is the foundation of protecting revenue.

The 30-day payment period

PDGM pays agencies per 30-day period rather than the previous 60-day episode. Certification periods remain 60 days, but each certification contains two 30-day payment periods, each independently grouped and paid.

Every 30-day period is classified into one of 432 Home Health Resource Groups (HHRGs) based on five variables, and each HHRG carries its own payment weight and LUPA threshold.

The five case-mix variables

Each 30-day period is scored on five dimensions:

Admission source - community or institutional (the 14 days prior determine this)
Timing - early (first 30-day period) or late (subsequent periods)
Clinical grouping - one of 12 groups from the principal diagnosis (e.g., wounds, neuro rehab, MMTA subgroups)
Functional impairment level - low, medium, or high, computed from OASIS functional items
Comorbidity adjustment - none, low, or high, from secondary diagnoses

What this means for revenue

Because payment is driven by diagnosis coding and OASIS accuracy rather than visit volume, documentation quality is now the primary revenue lever. An inaccurate functional score or an unsupported principal diagnosis changes the HHRG - and with it, the payment and the LUPA threshold.

Institutional admissions and early periods pay more, which makes fast, accurate intake processing a revenue function: the sooner a hospital-discharge referral is admitted, the sooner the higher-weighted period begins.

Common PDGM revenue leaks

Agencies lose PDGM revenue in predictable places:

Late NOAs reducing first-period payment by 1/30th per day
Avoidable LUPAs from missed visits near period boundaries
Downcoded functional levels from OASIS errors
Principal diagnoses that group to lower-weight clinical categories than the chart supports
Missed comorbidity adjustments from incomplete secondary diagnosis capture

Frequently asked questions

What does PDGM stand for?

Patient-Driven Groupings Model - the Medicare home health payment system effective January 1, 2020, which pays per 30-day period using 432 case-mix groups.

How many payment groups does PDGM have?

432. They result from combining admission source and timing (4 combinations), 12 clinical groupings, 3 functional impairment levels, and 3 comorbidity levels.

Does therapy volume still drive payment?

No. PDGM removed therapy visit thresholds from payment. Therapy is delivered based on clinical need documented in the assessment and plan of care.

See how the platform addresses the workflows covered in this guide:

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