HIPPS Code Scoring Tool
The Health Insurance Prospective Payment System (HIPPS) are codes which represent specific sets of patient characteristics known as case-mix groups. These codes determine the amount of payment the agency should receive for the episode of care. Many clinicians have difficulty understanding the relationship of HIPPS codes to HHRG (Home Health Resource Group) codes. Understanding the HHRG and HIPPS codes are vital to the financial well-being of the home health agency. This quick reference cheat sheet includes an easily understood breakdown of each element of the codes as well as a valuable audit tool. Additionally, there are examples of HIPPS codes which have been identified as triggers to medical review audits by Medicare contractors.