Home Health Billing Under PDGM: Get Your 2026 Reimbursement Right

Home Health billing has specific differences from other types of services.  There are physician certification requirements for ordering home health services.

The PDGM (Patient Driven Groupings Model)  concept was developed effective in 2020 & this arrangement drives the correct reporting & reimbursement.  HIPPS codes provide assessment of the patient’s ability to conduct certain activities (functional status) and the presence of any type of cognitive impairment to determine a payment group. HIPPS codes are required on all claims using revenue code 0023 on the UB 04.

We will review required documentation, completing the UB 04, & potential reimbursement changes for 2026

Webinar Objectives

• Understand the requirements for Home Health Billing
• Review required physician docmentation for ordering Home Health services.
• Understand the purpose of HIPPS codes
• Review how to calculate HIPPS codes
• Understand the PDGM concept
• Required documentation of services

Webinar Agenda

• Introduction to PDGM concept
• Review of Required HIPPS Codes
• Calculating the HIPPS Code for Revenue Code 0023
• Review of  UB04 Revenue Codes
• Documentation Requirements
• Possible 2026 reimbursement changes

Webinar Highlights

• Introduction & review of HIPPS codes
• What is meant by PDGM concrept?
• Understanding the different categories in PDGM
• Complete documentation will be key to correct reimbursement
• Denial management

Who Should Attend

• Chargemaster Maintenance Staff
• Physicians
• Practice managers
• Medical assistants
• Nurses
• Compliance staff
• Billers
• Coders
• Revenue Cycle
• Risk Management
• Charge entry staff
• Home Health providers & staff