Nov 25, 2015
Per the previously posted 11/9/15 QTSO post entitled "Potential Home Health Assessments HIPPS Score miscalculation", please assist your Providers with the procedures they should follow using your software in order to correct any assessments previously submitted and accepted since 10/1/15 that had a SPEC_VRSN_CD value assigned which was incompatible with the assessment's M0090_INFO_COMPLETED_DT time period (i.e. modify a previously-submitted assessment, or inactivate and re-submit a new original assessment).
To reiterate, in order for the HH-PPS grouper to calculate the HIPPS Score correctly, it is critical that vendors' software include the correct version of the Data Specification, to be submitted to the ASAP system along with the assessment record. The Data Specification versions and their compatible M0090_INFO_COMPLETED_DT time periods are shown below.
SPEC_VRSN_CD value= 2.10 M0090_INFO_COMPLETED_DT time period= 01/01/2010 - 12/31/2014
SPEC_VRSN_CD value= 2.11 M0090_INFO_COMPLETED_DT time period= 01/01/2015 - 9/30/2015
SPEC_VRSN_CD value= 2.12 M0090_INFO_COMPLETED_DT time period= On or after 10/1/2015
All vendors should review their software to ensure that the SPEC_VRSN_CD value for assessments with a M0090 date of 10/1/2015 or later is 2.12. It is important to review each time period and ensure the correct date range is being utilized for each SPEC_VRSN_CD.
The HHRG Grouper software utilizes the value provided in SPEC_VRSN_CD (indicating the version number of the Data Specifications) found in the submission file to determine what fields will be analyzed by the HHRG Grouper software in calculating the HIPPS Score. For Home Health assessments with a M0090 date of 10/1/2015 or later, the HHRG Grouper Software anticipates a Data Specification version number value of 2.12. Any other SPEC _VRSN_CD value results in a risk of miscalculating the HIPPS Code, as OASIS Items M01021, M01023 and M01025 will not be utilized in the calculation of the HIPPS Code. (*Please reference the HH PPS Summary of Changes document in the October 2015 HH PPS Grouper Software download, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/CaseMixGrouperSoftware.html).
Please be advised that CMS has updated the OASIS Data Specification V2.12.0 Errata Document which includes a new fatal edit that will reject assessment records submitted with a Data Specification version which is incompatible with the M0090_INFO_COMPLETED_DT time period of the submitted assessment. The new fatal edit -5460 was implemented into the ASAP system on 11/17/15, which will prevent assessments with an incompatible Data Specification version from being submitted and accepted to ASAP; however, any previously-submitted and accepted assessments since 10/1/15 that had a SPEC_VRSN_CD value assigned which was incompatible with the assessment's M0090_INFO_COMPLETED_DT time period must be modified, or inactivated and a new original assessment submitted, in order to ensure an accurate HIPPS Score calculation.
If you have any ASAP/Data Specification related questions, please feel free to contact the QIES Help desk at iqies@cms.hhs.gov. Please submit questions regarding the HHRG Grouper and/or the generated HIPPS Score to grouperemail@mmm.com.