Understanding PDPM and HIPPS Coding
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. The language of the Patient Driven Payment Model (PDPM) HIPPS coding is complex. The HIPPS code is only five digits however there are many combinations of those digits under PDPM. Once you understand what each digit…
