HOME HEALTH · PDGM SCENARIO SIMULATOR

PDGM Scenario Simulator

Model how clinical grouping, admission source, timing, functional impairment, comorbidity coding, and visit utilization move the home-health 30-day period payment, LUPA risk, and episode margin — live as you change inputs. Built for administrators, DONs, clinical managers, coders, and finance teams, not just billing.

Load example

Patient & Episode

30-Day Period

Functional & Comorbidity

Case-Mix

Visit Utilization

Planned Visits
Skilled Nursing
Physical Therapy
Occupational Therapy
Speech (SLP)
Home Health Aide
Medical Social Work
Total visits13

Financial Assumptions

Cost Model

Estimated Reimbursement

CY2026

LUPA Risk

Per-Visit Threshold

Margin & Efficiency

Estimate

Reimbursement Breakdown

Case-Mix Build

Optimization Insights

Live

Scenario Comparison