Case Mix Calculation
Case Mix Calculation combines the patient's clinical grouping, functional impairment level, timing, admission source, and comorbidity adjustment to determine the PDGM payment.
Definition
Case Mix Calculation combines the patient's clinical grouping, functional impairment level, timing, admission source, and comorbidity adjustment to determine the PDGM payment.
Why it matters
Case Mix Calculation is part of the Revenue Cycle vocabulary used across home health operations, documentation, and revenue cycle. Understanding it helps clinicians, QA leads, and administrators stay aligned on care quality and compliance.
Texas Home Health Payer Contracting Playbook
When a Texas payer says “our network is closed,” it doesn’t mean every door is shut. This playbook explores three paths to pursue payer contracts, access referral networks, and secure out-of-network payments. Learn which three numbers payers check first, and how to build a stronger case for your agency.
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