Prospective Payment System:
HIPPS CODES INCREASE 1100% UNDER PPS REFINEMENTS
Published on Tue Sep 18, 2007
Can you handle 1,836 new HIPPS code?
Home health agencies are doing a double take about the vastly increased number of new HIPPS codes required by the revised prospective payment system.
Starting Jan. 1, HHAs must use 1,836 HIPPS codes, the Centers for Medicare & Medicaid Services’ Wil Gehne said in an Oct. 9 session at the National Association for Home Care & Hospice’s annual meeting in Denver. That’s 11 times more than the current 153 HIPPS codes.
And the codes themselves are getting a major makeover, CMS explains in the Oct. 5 Transmittal 1348 (CR 5746) detailing the changes. Here are the main differences: • 1st digit. The current HIPPS code always starts with an “H,” Gehne pointed out in the session. Starting Jan. 1, the first digit will correspond to the group the episode belongs to. The choices range from assigning a “1” for an early episode with 0-14 therapy visits to a “five” for an episode with more than 20 therapy visits. • Digits 2-4. These digits will remain the most unchanged from the current HIPPS code. They still will reflect the Clinical, Functional and Service dimension scores as they do currently. However, they will represent them with letters instead of numbers. So a Clinical dimension HHRG score of C1 will translate to an “A” in the HIPPS code.
Note: CMS did not use “O” in the Service dimension letters because it often gets confused with zero, Gehne explained. • 5th digit. Currently this digit is a validity indicator for the OASIS data used to generate the HIPPS code, Gehne noted. Under the prospective payment system revisions, it will indicate the level of Nonroutine Supplies (NRS) usage.
Wrinkle: But it’s not just a straightforward NRS level indicator. There’s a set of letters (S-X) for NRS severity levels when the billing agency does furnish supplies and a set of numbers (1-6) for when the HHA does not furnish them.
The dual set of NRS indicators is necessary because CMS plans to return to provider (RTP) claims that don’t include required supplies line items, Gehne explained to conference attendees.
Example: A patient in an early episode with an HHRG of C1F1S1, 0 therapy visits and a NRS level of 2 would have a HIPPS code of 1AFKT if the agency furnished supplies and 1AFK2 if it didn’t. Supplies Edits Not Far Behind Implementation A breather: HHAs don’t have to worry about reporting supplies immediately. CMS will hold off on NRS edits until April, the agency says in the transmittal. And it first will implement informational edits during a [...]
