Beginning October 1, 2019 providers will need to begin coding a new set of Health Insurance Prospective Payment System (HIPPS) codes in Section Z0100A of the MDS as well as on the Part A claim. This coding of HIPPS codes will identify the resident’s SNF PDPM classification for payment.

Like RUG-IV HIPPS codes, PDPM will also use five characters in the HIPPS code.  Below is a breakdown of what each character represents:

  1. The first character represents the resident’s PT and OT payment group.
  2. The second character represents the resident’s SLP payment.
  3. The third character represents the resident’s nursing payment group.
  4. The fourth character represents the NTA payment group.
  5. The fifth character represents the resident’s assessment used to classify the resident.

Keep in mind that PT and OT use the same component classification process so they will have the same payment group. For this reason, they will share one character of the HIPPS code.  Another thing to keep in mind is that even though PT and OT use the same classification process, their case-mix is calculated separately. CMS provides this example: a resident who classifies into the TC case-mix group for PT will also classify into the TC case-mix group for OT. But the TC will pay differently for PT than OT due to the base rate difference and Case-Mix Indexes.

 

 

 

Example 1:

  • PT/OT Payment Group: TN
  • SLP Payment Group: SH
  • NTA Payment Group: NC
  • Nursing Payment Group: CBC2
  • Assessment Type: 5-Day PPS Assessment
  • HIPPS Code: NCHN1

Example 2:

  • PT/OT Payment Group: TN
  • SLP Payment Group: SH
  • NTA Payment Group: NC
  • Nursing Payment Group: CBC2
  • Assessment Type: 5-Day PPS Assessment
  • HIPPS Code: NCHN1

 

Keep an eye on CMS PDPM Webpage for updates.

 

Gina Tomcsik
Director of Compliance