PDPM & HIPPS

MEDICAID HIPPS CODE CALCULATION ISSUE

On October 30, 2023, a notification was sent regarding an issue with the grouper that was using the response codes for the applicable data elements in GG0130 & GG0170 column 1 (Admission Performance) instead of column 5 (OBRA/Interim Performance) on one or more assessments for the provider that you support. Because of this, the grouper did not correctly calculate the Medicaid HIPPS code on some standalone OBRA assessments with a Target Date and Submission Date on or after October 1, 2023. Some assessments that had an incorrect Medicaid HIPPS code would not have received the error –3935a on the Final Validation Report since the submitted HIPPS, which was incorrect, matched the recalculated HIPPS code, which was also incorrect.  

The grouper issue that caused the incorrect HIPPS code to be calculated has been corrected and the affected assessments have been assigned a correct system-calculated value; however, new Final Validation Reports with the correct value are not being reissued. Instead, CMS has made available a file labeled MDS_FVR_Addendum_for_HIPPS_code_correction_ccn_XXXXXX.csv in your MDS 3.0 Final Validation Report folder which contains the correct system-calculated HIPPS code for each affected assessment.

The file name will include the provider's CCN in place of XXXXXX. The files in the MDS 3.0 Final Validation Report folder are displayed in descending order by date, but to easily locate the file you may search by file name (partial or full file name, note: the search is case sensitive) or by CCN. The CSV file contains the following information to allow you to identify the affected assessment on the original Final Validation Report, as well as provides you with the correct system-calculated HIPPS code:   

• CCN  

• Submission ID  

• Submission Timestamp  

• Assessment ID  

• Resident ID  

• Incorrect iQIES calculated Z0100A HIPPS Code  

• Corrected iQIES calculated Z0100A HIPPS Code  

CMS is directing you to check the folder referenced above for the CSV file and utilize the corrected HIPPS code on any associated Medicaid claims, where applicable. Since an impacted assessment may not have received error code –3935a, CMS strongly recommends you review the file thoroughly.  

iQIES Service Center   

If you have questions or require assistance, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email.