ICD-10 Implementation will Impact HIPPS Case Mix Groups

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ICD-10 Implementation will Impact HIPPS Case Mix Groups

ICD-10 will re-write the book on diagnosis and procedure coding, utilization pattern history will shift.  HIPPS and ICD-10 should not be viewed as separate issues for ICD-10 assessments.

The Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics (or case-mix groups) on which payment determinations are made under several prospective payment systems. Case-mix groups are developed based on research into utilization patterns among various provider types.  The Centers for Medicare and Medicaid Services (CMS) created HIPPS codes as part of the Medicare program’s implementation of a prospective payment system for skilled nursing facilities in 1998.

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By | 2017-05-04T04:06:53+00:00 November 7th, 2011|HIPPS, ICD-10, ICD-10 Assessment, ICD10|0 Comments

About the Author:

Michael is Managing Partner & CEO of No World Borders, a leading health care management and IT consulting firm. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $4 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, Stanford Medical School - Biomedical Informatics, Harvard Law School - Bioethics.
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