? How To: Resolve HIPPS Code Not Showing on Plan of Care

Issue Summary

The HIPPS code may fail to display on the Plan of Care even though it’s generated correctly and appears in other areas (such as OASIS, billing, or claims). This issue typically stems from incomplete or incorrect insurance setup settings.

Cause

When the insurance setup does not include the correct PPS and HIPPS configuration, the system omits the HIPPS code from the Plan of Care output.

Resolution Steps

Step 1: Access the Insurance Setup

1. Navigate to Claims → Insurance Settings.

2. Select the affected insurance payer from the list.

3. Open the payer record to review and edit its configuration.

Step 2: Verify and Correct the Settings

Ensure your settings match the configuration below:

✅ Check if the insurance requires OASIS
✅ Bill Under PPS

• Enable: Effective 01/01/08 use new PPS Payment method

• Enable: Auto Adjust Claim Amount to Match Total Payments

✅ Include HIPPS code show Quantity as 0 or 1

• Choose 0 or 1 based on whether you want to show the HIPPS quantity on the claim or report.

✅ Use PDGM HIPPS Code

• Enter PDGM Effective Date: 01/01/2020 (or your agency’s PDGM start date).

These settings ensure that HIPPS codes generate under PDGM (Patient-Driven Groupings Model) and are displayed properly on the Plan of Care.

Step 3: Save and Apply

1. Click Save to update the insurance configuration.

2. Exit the insurance setup.

3. Regenerate or reopen the Plan of Care for a patient using this insurance payer.

Step 4: Verify Resolution

• Open the Plan of Care and confirm that the HIPPS code now appears in the appropriate section.

• The HIPPS code should match the value visible in the OASIS or billing module.

Verification Tip

If the HIPPS code still does not display:

• Verify the OASIS is completed and exported successfully.

• Ensure the Plan of Care is linked to the correct episode and payer.

• Recheck the PDGM effective date and confirm it aligns with your agency’s setup.

Prevention Best Practices

• Always confirm that newly added payers have Bill Under PPS, Include HIPPS code, and Use PDGM HIPPS Code options selected.

• Audit payer settings after any system upgrade or regulatory update.

• Train billing and admin staff to verify payer configuration before creating patient episodes.

This FAQ was generated based on Synergy AI/EMR App Version 7.0.38.36159 and Dashboards Version: 7.0.38.14741

Important: The information in this FAQ is based on the software version available at the time of publication and is subject to change. Please use the software responsibly. HealthCare Synergy is not liable for any issues resulting from outdated or incorrect use of this information.