Questionnaire Questionnaire Form "*" indicates required fields Δ Please answer all questions below Unless otherwise specified, all numbers should be referring to PDGM in 2024.Name* First Last Email* PhoneCompanyQuestionnaireAverage HHRG payment*Average 1-30 Day Payment*Average 31-60 Day Payment*Average Case Mix Index*Total Average of Referrals (ALL Payors) per Month*Average Monthly % of Episodic Referrals*Average daily census*Average Nursing visits per 30-day billing cycle*Average Therapy visits per episode*Average HHA visits per episode*Average episodic LUPA rate (average # per month)*Average 1-30 Day # of episodic LUPAs*Average 31-60 Day # of episodic LUPAs*Average Missed Visits per month (All Disciplines)*Average Number of NTUC Admissions/Not Taken Under Care (per month)*Current Star Rating*TPS Score*TPS Percentile/Ranking*VBP Adjustment % (Positive or Negative)*What EMR do you use?*What star rating scrubber service do you use?*Please send your most current APR and IPR Reports from IQIES Drop files here or Select files Accepted file types: pdf, doc, docx, xls, xlsx, ppt, pptx, Max. file size: 2 GB.
