Fixing Missing HIPPS Codes

The OASIS and Plan of Care (POC) are completed, but no HIPPS code is generated.

Steps to Troubleshoot:

1. Check Primary Diagnosis in Plan of Care:
   
   
   • Open the patient's Plan of Care.
     
     
   • Make sure the primary diagnosis is assigned to a PDGM clinical group.
     
     
   • If not, select an appropriate diagnosis that maps to a clinical group.
     
     
2. Resave the Plan of Care:
   
   
   • If the primary diagnosis is correct but HIPPS is still missing, try resaving the Plan of Care to trigger HIPPS generation.
     
     
3. Verify Insurance Settings:
   
   
   • Go to Claims/Auth > Insurance Settings.
     
     
   • Check if “Use PDGM HIPPS code” is enabled for the patient's insurance.
     
     
   • If unchecked, the system will not generate a HIPPS code.
     
     
4. Review OASIS for Case-Mix Data:
   
   
   • Open the patient's OASIS assessment.
     
     
   • Ensure all case mix–relevant questions (functional and clinical items) are completed.
     
     
   • Missing or incomplete responses may prevent HIPPS generation.
     
     

Tip:  After making corrections, revalidate or resave the Plan of Care or OASIS to prompt the system to generate the HIPPS code.

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 HealthCare Synergy is not liable for any issues resulting from outdated or incorrect use of this information.