PPS_INFO

Description: |
New table for the Hospital Accounts Receivable (HAR) to specify what assessed HIPPS code and reimbursement amount is versus the charge-based HIPPS code and reimbursement amount.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
ACCT_ID | 1 |
LINE | 2 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | ACCT_ID | NUMERIC | No |
The unique identifier for the hospital account record.
2 | LINE | INTEGER | No |
The line number for the information associated with this record. Multiple pieces of information can be associated with this record.
3 | PPS_TYPE_C_NAME | VARCHAR | No |
This category holds the data that indicates what type of data is on the row. A row can represent the pricing from the assessment or the pricing from the charges (what really happened).
May contain organization-specific values: No
Category Entries:
PPS / Assessment-Based
Expected Final / Charge-Based
4 | HIPPS_CODE | VARCHAR | No |
Stores the calculated HIPPS code. Item HAR 680 stores if it is assessment based or charge based.
5 | EXP_PAYMENT | NUMERIC | No |
Expected payment for the associated HIPPS code. Multiple responses are permitted (one per line).
6 | NRS_AMOUNT | NUMERIC | No |
Non routine supply amount for the associated HIPPS code. Multiple responses are permitted (one per line).
7 | EPISODE_RATE | NUMERIC | No |
The episode rate for the associated HIPPS code.
8 | PAYMENT_CASE_C_NAME | VARCHAR | No |
Payment case for the associated HIPPS code.
May contain organization-specific values: No
Category Entries:
None
Full Episode Rate
LUPA
PEP
SCIC
No-Visit RAP
9 | ADD_ON_LUPA | NUMERIC | No |
This item stores the Low Utilization Payment Adjustment (LUPA) add on amount.
10 | ADD_ON_RURAL | NUMERIC | No |
This item stores the rural add on amount.
11 | ADD_ON_OUTLIER | NUMERIC | No |
This item stores the outlier add on amount.
12 | LOCALE_ID | NUMERIC | No |
The unique identifier for the locale record for this row.
13 | LOCALE_ID_LOCALE_NAME | VARCHAR | No |
The name of the locale record.
14 | EPISODE_TIMING_C_NAME | VARCHAR | No |
The episode timing for this Home Health PDGM account.
May contain organization-specific values: No
Category Entries:
Early
Late
Missing
15 | ADMIT_SOURCE_C_NAME | VARCHAR | No |
The admission source for this Home Health PDGM account.
May contain organization-specific values: No
Category Entries:
Community
Institutional
Missing
16 | CLINICAL_GROUP_C_NAME | VARCHAR | No |
The clinical group for this Home Health PDGM account.
May contain organization-specific values: No
Category Entries:
MMTA - Other
Neuro/Stroke Rehabilitation
Wound Care
Complex Nursing Interventions
Musculoskeletal Rehabilitation
Behavioral Health
MMTA - Surgical Aftercare
MMTA - Cardiac
MMTA - Endocrine
MMTA - GI/GU
MMTA - Infectious
MMTA - Respiratory
Missing Primary Diagnosis
Questionable Encounter
17 | FUNCTIONAL_LEVEL_C_NAME | VARCHAR | No |
The functional impairment level for this Home Health PDGM account.
May contain organization-specific values: No
Category Entries:
Low
Medium
High
18 | COMORBIDITY_ADJUSTMENT_C_NAME | VARCHAR | No |
The comorbidity adjustment for this Home Health PDGM account.
May contain organization-specific values: No
Category Entries:
No Comorbidity
Low Comorbidity
High Comorbidity