HIPPS rate codes are used for payment determinations under several prospective payment systems. Which is an example of systems where HIPPS are used?

HIPPS rate codes are used for payment determinations under several prospective payment systems. Which is an example of systems where HIPPS are used?

• A. Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Home Health Agencies
• B. General acute care hospitals only
• C. Outpatient clinics
• D. Pharmacy benefit managers

Answer: (A)

HIPPS codes are used to determine payment amounts under certain post-acute prospective payment systems. The correct example includes Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Home Health Agencies because these settings all use HIPPS-based PPS to establish payment rates based on patient characteristics and resource use. General acute care hospitals are paid with DRGs, not HIPPS; outpatient clinics rely on outpatient prospective payment methods or APCs rather than HIPPS; and pharmacy benefit managers operate in drug benefits rather than PPS payment systems. So, the settings listed are the ones where HIPPS rate codes drive payment determinations.

HIPPS codes are used to determine payment amounts under certain post-acute prospective payment systems. The correct example includes Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Home Health Agencies because these settings all use HIPPS-based PPS to establish payment rates based on patient characteristics and resource use. General acute care hospitals are paid with DRGs, not HIPPS; outpatient clinics rely on outpatient prospective payment methods or APCs rather than HIPPS; and pharmacy benefit managers operate in drug benefits rather than PPS payment systems. So, the settings listed are the ones where HIPPS rate codes drive payment determinations.