PDGM, the Patient-Driven Groupings Model, is the Medicare payment system for home health that pays agencies based on 30-day periods of care and patient characteristics rather than the volume of therapy visits provided.
What it means
Under the Patient-Driven Groupings Model, Medicare splits a 60-day home health episode into two 30-day payment periods. Each period is classified by clinical and patient factors, and the agency is paid for that period rather than for the number of therapy visits delivered. The model took effect in 2020 and reshaped how home health agencies are reimbursed.
PDGM also changed the timing of cash. A request for anticipated payment that once delivered money early in an episode was phased down and ended, so agencies now carry the full cost of care across each 30-day period before the payment for that period arrives.
The result is a recurring gap. An agency staffs nurses and aides, drives to homes, and documents visits across a 30-day period while the reimbursement for that period is still being processed.
Why it matters for your practice
For a home health agency owner, PDGM means you fund every 30-day period of care up front. Clinician wages, mileage, and supplies go out on a weekly payroll while the payment for that period lands later. The 30-day structure turns into a standing working capital gap that grows with every patient you take on.
How this relates to Copay
Copay closes that gap by purchasing your eligible home health claims and paying you the next business day, rather than making you wait out the 30-day period and its processing. You bill under PDGM exactly as you do now, and Copay reconciles when Medicare pays. This is not a loan and not factoring, and a denied eligible claim is Copay's loss, not yours.
Written by Eitan Glick, CEO, Copay Inc.
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