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Additional information regarding PDPM classification and HIPPS codes can be found in Chapter 6 of the Resident Assessment Instrument Manual. The tables below provide the information that will assist you in determining the HIPPS code for
12 Απρ 2024 · In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.
The following crosswalk describes how PDPM HIPPS codes are derived: The first, second and fourth positions of the code use this table to translate PT/OT, SLP, NTA Payment Groups into code values:
Use the following at-a-glance tools to identify the case-mix group for each component and improve your understanding of the Patient-Driven Payment Model. NOTE: This document is intended to aid members in their review of the Patient-Driven Payment Model.
The MDS assessment data is used to calculate the resident’s Patient Driven Payment Model (PDPM) classification necessary for payment. The MDS contains extensive information on the resident’s nursing and therapy needs, ADL status, cognitive status, behavioral problems, and medical diagnoses.
PDPM Case-Mix Group Conversion to HIPPS Characters PT/OT Payment Group SLP Payment Group Nursing Payment Group NTA Payment Group HIPPS Character TA SA ES3 NA A TB SB ES2 NB B TC SC ES1 NC C TD SD HDE2 ND D TE SE HDE1 NE E TF SF HBC2 NF F TG SG HBC1 G TH SH LDE2 H TI SI LDE1 I TJ SJ LBC2 J TK SK LBC1 K TL SL CDE2 L TM CDE1 M TN CBC2 N TO CA2 O
28 Φεβ 2024 · Health Insurance Prospective Payment System rate codes, known as HIPPS codes, represent specific sets of patient characteristics (or case-mix groups) on which payment determinations are made under several prospective payment systems (PPS). These HIPPS codes are reported on claims to insurers.
