CMS Delays HIPPS Coding Requirement on MA Plans Until December 1, 2013

Nancy Leveille and Karen Morris in Clinical & Quality

Per a recent AHCA memo, CMS is delaying until December 1, 2013 a new HIPPS coding requirement that will require Medicare Advantage Organizations (MAOs) to submit HIPPS codes on their SNF and home health claims. After hearing AHCA’s concerns, and the concerns of the health plan and home health communities, CMS has decided to delay this requirement. Effective July 1st, MAOs will receive an “informational” edit for SNF and HH encounters submitted without HIPPS codes, but payment will not be denied. Effective December 1st, informational edits will change over to “Reject” edits, preventing the plans from submitting those encounters.  See attached.

This does not mean that SNF claims submitted to MAOs will be automatically denied payment. Providers should be communicating with the MAOs with whom they have contracts to determine the appropriate steps necessary to avoid potential delays in payment. Over the next several months, CMS will be working with MAOs to implement this requirement. AHCA will stay engaged with CMS, and we will continue to voice our members’ questions and concerns. In the meantime, should you have any questions about this requirement, please feel free to contact James Michel, AHCA Director Medicare Research and Reimbursement directly at

NYSHFA contacts: 

Nancy Leveille
Sr. Director, Member Operational Support Services
518-462-4800 ext 20 


Karen Morris
Director, Clinical & Quality Services
518-462-4800 ext 15 

 refer to mm2013-377