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

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="CMSHIPPSCodes"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url
       value="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes"/>
  <version value="1.1.0"/>
  <name value="CMSHIPPSCodes"/>
  <title value="Health Insurance Prospective Payment System (HIPPS)"/>
  <status value="active"/>
  <date value="2021-07-02T17:53:32+00:00"/>
  <publisher value="HL7 Financial Management Working Group"/>
  <contact>
    <name value="HL7 Financial Management Working Group"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm/index.cfm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fm@lists.HL7.org"/>
    </telecom>
  </contact>
  <description
               value="Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets
of patient characteristics (or case-mix groups) health insurers use to make payment
determinations under several prospective payment systems. Case-mix groups are
developed based on research into utilization patterns among various provider types. For
the payment systems that use HIPPS codes, clinical assessment data is the basic input. A
standard patient assessment instrument is interpreted by case-mix grouping software
algorithms, which assign the case mix group. For payment purposes, at least one HIPPS
code is defined to represent each case-mix group. These HIPPS codes are reported on
claims to insurers.
Institutional providers use HIPPS codes on claims in association with special revenue
codes. One revenue code is defined for each prospective payment system that requires
HIPPS codes. HIPPS codes are placed in data element SV202 on the electronic 837
institutional claims transaction, using an HP qualifier, or in Form Locator (FL) 44
(&quot;HCPCS/rate&quot;) on a paper UB-04 claims form. The associated revenue code is placed in
data element SV201 or in FL 42. In certain circumstances, multiple HIPPS codes may
appear on separate lines of a single claim.

HIPPS codes are alpha-numeric codes of five digits. Each code contains intelligence,
with certain positions of the code indicating the case mix group itself, and other positions
providing additional information. The additional information varies among HIPPS codes
pertaining to different payment systems, but often provides information about the clinical
assessment used to arrive at the code. Which positions of the code carry the case mix
group information may also vary by payment systems."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <copyright
             value="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 value="not-present"/>
</CodeSystem>