Transcription of Definition and Uses of Health Insurance Prospective ...
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Definition and Uses of Health Insurance Prospective ...
CMS Division of Inst itu t io nal Claims Pro cess ing A p ril 4, 2022 HIPPS Code Maintenance Process 1 Ve r s ion 10 De finition and Us e s of He alth Ins urance Pros pe ctive Payme nt Sys te m Code s (HIPPS Code s ) D e f inition 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 utilizat ion patterns among various provider types.
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. The specific composition of HIPPS codes for past and current payment systems is described in detail below.
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