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: Health Insurance Prospective Payment System (HIPPS) - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "CMSHIPPSCodes",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes defines many codes, but they are not represented here</p></div>"
  },
  "url" : "https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes",
  "version" : "1.1.0",
  "name" : "CMSHIPPSCodes",
  "title" : "Health Insurance Prospective Payment System (HIPPS)",
  "status" : "active",
  "date" : "2021-07-02T17:53:32+00:00",
  "publisher" : "HL7 Financial Management Working Group",
  "contact" : [
    {
      "name" : "HL7 Financial Management Working Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm/index.cfm"
        },
        {
          "system" : "email",
          "value" : "fm@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets\nof patient characteristics (or case-mix groups) health insurers use to make payment\ndeterminations under several prospective payment systems. Case-mix groups are\ndeveloped based on research into utilization patterns among various provider types. For\nthe payment systems that use HIPPS codes, clinical assessment data is the basic input. A\nstandard patient assessment instrument is interpreted by case-mix grouping software\nalgorithms, which assign the case mix group. For payment purposes, at least one HIPPS\ncode is defined to represent each case-mix group. These HIPPS codes are reported on\nclaims to insurers.\nInstitutional providers use HIPPS codes on claims in association with special revenue\ncodes. One revenue code is defined for each prospective payment system that requires\nHIPPS codes. HIPPS codes are placed in data element SV202 on the electronic 837\ninstitutional claims transaction, using an HP qualifier, or in Form Locator (FL) 44\n(\"HCPCS/rate\") on a paper UB-04 claims form. The associated revenue code is placed in\ndata element SV201 or in FL 42. In certain circumstances, multiple HIPPS codes may\nappear on separate lines of a single claim.\n\nHIPPS codes are alpha-numeric codes of five digits. Each code contains intelligence,\nwith certain positions of the code indicating the case mix group itself, and other positions\nproviding additional information. The additional information varies among HIPPS codes\npertaining to different payment systems, but often provides information about the clinical\nassessment used to arrive at the code. Which positions of the code carry the case mix\ngroup information may also vary by payment systems.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "copyright" : "CMS maintains HIPPS. There are no known constraints on the use of HIPPS. See more information about HIPPS codes [here](https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes)",
  "content" : "not-present"
}