Quick links:  MS-DRG Codes | HCAHPS Service Line and V.34 APR-DRG Crosswalk | Data Submission Deadlines Through April 2025 | Updates to HCAHPS Public Reporting on Care Compare | 25 Completed HCAHPS Surveys Required for Hospital HCAHPS Scores to be Publicly Reported on Hospital Compare | Submission of HCAHPS Administrative Data | HCAHPS Public Reporting Periods | IPPS and OPPS Rules | HCAHPS V4.6 Submission of “5 or Fewer Eligible HCAHPS Discharges in a Month” | HCAHPS V4.6 Submission of "Zero Cases" | XML File Specifications Version 4.6 | HCAHPS V4.5 Submission of "5 or Fewer Eligible HCAHPS Discharges in a Month" | HCAHPS V4.5 Submission of "Zero Cases | XML File Specifications Version 4.5 

V.42 MS-DRG Codes Effective October 1, 2024 (10/09/2024)

CMS has adopted V.42 MS-DRG Codes effective October 1, 2024. Please click here for the Table of V.42 MS-DRG Codes and HCAHPS Service Line Categories.

V.41 MS-DRG Codes Effective October 1, 2023 (10/06/2023)

CMS has adopted V.41 MS-DRG Codes effective October 1, 2023. Please click here for the Table of V.41 MS-DRG Codes and HCAHPS Service Line Categories.

Previous MS-DRG Codes:

• V.40 MS-DRG Codes Effective October 1, 2022
• V.39 MS-DRG Codes Effective October 1, 2021
• V.38 MS-DRG Codes Effective October 1, 2020
• V.37 MS-DRG Codes Effective October 1, 2019
• V.36 MS-DRG Codes Effective October 1, 2018
• V.35 MS-DRG Codes Effective October 1, 2017
• V.34 MS-DRG Codes Effective October 1, 2016

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HCAHPS Service Line and V.34 APR-DRG Crosswalk (08/31/2018)

Please click here for the Crosswalk of HCAHPS Service Line Categories and V.34 APR-DRG Codes

Previous APR-DRG HCAHPS Service Lines and Crosswalks:

• HCAHPS Service Line and V.31 APR-DRG Crosswalk

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Data Submission Deadlines Through April 2025

The HCAHPS Data Submission Deadlines through April 2025 are listed below. Following the HCAHPS Data Submission Deadline, hospitals self-administering the HCAHPS Survey and HCAHPS Survey vendors will have a one week opportunity to correct data previously submitted for the quarter. The Review and Correct Period is only for correcting previously submitted data and cannot be used to submit new data records.

The process for submitting corrected data will be the same as the current process used for correcting data. During the Review and Correct Period only administrative data and survey record data can be corrected.

The Review and Correct Report, which summarizes the data submitted to the HCAHPS Data Warehouse, is available to hospitals and survey vendors in the Review and Correction Period.

The October 2023 through April 2025 HCAHPS Data Submission Deadlines are as follows:

• October 4, 2023 is the data submission deadline for the patients discharged in April, May, and June 2023 (2Q23). June 2023 Dry Run data must also be submitted by this date.
  • October 5 - 11, 2023 Review and Correct Period
• January 3, 2024 is the data submission deadline for the patients discharged in July, August, and September 2023 (3Q23). September 2023 Dry Run data must also be submitted by this date.
  • January 4 - 10, 2024 Review and Correct Period
• April 3, 2024 is the data submission deadline for the patients discharged in October, November, and December 2023 (4Q23). December 2023 Dry Run data must also be submitted by this date.
  • April 4 - 10, 2024 Review and Correct Period
• July 3, 2024 is the data submission deadline for the patients discharged in January, February and March 2024 (1Q24). March 2024 Dry Run data must also be submitted by this date.
  
  • July 4 - 10, 2024 Review and Correct Period
• October 2, 2024 is the data submission deadline for the patients discharged in April, May and June 2024 (2Q24). June 2024 Dry Run data must also be submitted by this date.
  • October 3 - 9, 2024 Review and Correct Period
• January 2, 2025 is the data submission deadline for patients discharged in July, August, and September 2024 (3Q24). September 2024 Dry Run data must also be submitted by this date.
  • January 3 - 9, 2025 Review and Correct Period
• April 2, 2025 is the data submission deadline for the patients discharged in October, November, and December 2024 (4Q24). December 2024 Dry Run data must also be submitted by this date.
  • April 3 - 9, 2025 Review and Correct Period

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Updates to HCAHPS Public Reporting on Care Compare (12/17/2024)

Official HCAHPS scores, which are based on four consecutive quarters of patient surveys, are publicly reported on Care Compare on Medicare.gov four times each year, with the oldest quarter of surveys rolling off as the newest quarter rolls on. A link to the downloadable version of HCAHPS results is also publicly available. HCAHPS scores are designed and intended for use at the hospital level for the comparison of hospitals. Hospitals must have a minimum of 25 completed surveys in a four-quarter period for their HCAHPS results to be publicly reported. Current HCAHPS scores, as well as an archive of historical scores, are available in a downloadable database found in the “Hospitals” tab on the Provider Data Catalog tool.

Because four quarters of HCAHPS data are required for public reporting, there will be changes to the roster of HCAHPS measures on Care Compare between the October 2025 and October 2026:

• Until October 2025: 10 HCAHPS measures: (Communications with Nurses, Communication with Doctors, Responsiveness of Hospital Staff, Communication about Medicines, Cleanliness of Hospital Environment, Discharge Information, Care Transition, Overall Hospital Rating, and Recommend the Hospital)

• January, April, and July 2026: 8 HCAHPS measures: (Communication with Nurses, Communication with Doctors, Communication about Medicines, Cleanliness of Hospital Environment, Quietness of Hospital Environment, Discharge Information, Overall Hospital Rating, and Recommend the Hospital)

• October 2026 and forward: 11 HCAHPS measures: (Communication with Nurses, Communication with Doctors, Restfulness of Hospital Environment, Care Coordination, Responsiveness of Hospital Staff, Communication about Medicines, Discharge Information, Cleanliness of Hospital Environment, Information about Symptoms, Overall Hospital Rating, and Recommend the Hospital)

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25 Completed HCAHPS Surveys Required for Hospital HCAHPS Scores to be Publicly Reported on Hospital Compare (08/15/2018)

Beginning with the December 2016 Hospital Compare refresh, HCAHPS scores based on fewer than 25 completed surveys will no longer be publicly reported. From December forward, the Hospital Compare Web site will report “Not Applicable” and Footnote 1: "The number of cases/patients is too few to report," for hospitals that have fewer than 25 completed HCAHPS Surveys. However, the Public Reporting Preview Report, which a hospital can access during the preview period, will continue to include the hospital’s HCAHPS scores and number of completed surveys.

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Submission of HCAHPS Administrative Data (03/31/2016)

The HCAHPS Project Team would like to remind hospitals and survey vendors that hospitals are required to provide, in a timely manner, all patient administrative data required for the HCAHPS Survey, including service line and patient age; see FY 2014 IPPS Final Rule (Federal Register/Vol. 78, No. 160/Monday, August 19, 2013/Rules and Regulations, Section. 412.140). These data are required for Patient-Mix Adjustment. Failure to provide this information is considered a deviation from HCAHPS data collection protocols.

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HCAHPS Public Reporting Periods for October 2023 Through October 2025 Have Been Updated (08/29/2024)

Click here to view the HCAHPS Public Reporting Periods document. This document indicates which calendar quarters of HCAHPS results will be publicly reported on Care Compare on Medicare.gov (https://www.medicare.gov/care-compare/) through October 2025.

Please Note: The dates of future preview periods and public reporting are estimates based on current timetables and thus are subject to change.

Previous HCAHPS Public Reporting Periods Document(s):

• April 2022 - October 2024
• October 2021 - October 2023
• October 2020 - October 2023
• October 2020 - January 2022
• January 2020 - October 2021

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IPPS and OPPS Rules

FY 2025 IPPS Final Rule Has Been Published (08/29/2024)

The FY 2025 IPPS Final Rule is now available on the Federal Register.

The Final Rule and related tables are available at the following URL: 2024-17021.pdf (federalregister.gov)

Previous IPPS Final Rules:

• FY 2024 IPPS Final Rule
• FY 2023 IPPS Final Rule
• FY 2022 IPPS Final Rule
• FY 2021 IPPS Final Rule
• FY 2020 IPPS Final Rule
• FY 2019 IPPS Final Rule

CY 2019 OPPS Final Rule (Combating the Opioid Crisis)

The CY 2019 OPPS Final Rule is now published.

The Final Rule and related tables are available at the following URL: https://www.gpo.gov/fdsys/pkg/FR-2018-11-21/pdf/2018-24243.pdf

Previous OPPS Final Rules:

• CY 2018 OPPS Final Rule
• CY 2017 OPPS Final Rule

CMS is finalizing the removal of the Pain Management dimension from the scoring formula used in the Hospital Value-Based Purchasing Program (Hospital VBP), beginning with the FY 2018 payment adjustments. The Pain Management dimension is derived from Questions 12, 13 and 14 on the HCAHPS Survey.

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HCAHPS V4.6 Submission of "5 or Fewer Eligible HCAHPS Discharges in a Month"

Below please find instructions for uploading "5 or Fewer Eligible HCAHPS Discharges in a Month" information via QualityNet using the HCAHPS Data Form or the XML file format for July 1, 2023 patient discharges and forward.

HCAHPS Data Form

Please note the following: 

·  One header record must be completed for each month that an organization has "Zero Cases"

·  The NPI element is not required at this time, but may be entered if the information is available

·  For "survey mode," select "Mail only"

·  For "determination of service line," select "1 – V.41, V.40, V.39, V.38, V.37, V.36, V.35, V.34, V.33, V.32, V.31, V.30, V.29, V.28, V.27, V.26, or V.25 MS-DRG codes"

·  For "number eligible discharge," and "sample size" enter 0

·  For "sample type," select "Simple Random Sample"

XML File Format

Below is an example of the header record layout that must be submitted for each month that an organization has "5 or Fewer Eligible HCAHPS Discharges in a Month."

 <header>
            <provider-name>Some Hospital</provider-name>
            <provider-id>123456</provider-id>
            (NPI is not required)
            <discharge-yr>2023</discharge-yr>
            <discharge-month>7</discharge-month> (for July)
            <survey-mode>1</survey-mode> (for Mail only)
            <determination-of-service-line>1</determination-of-service-line> (for V.41, V.40, V.39, V.38, V.37, V.36, V.35, V.34, V.33, V.32, V.31, V.30, V.29, V.28, V.27, V.26, or V.25 MS-DRG codes)
            <number-eligible-discharge>enter actual count i.e. 1, 2, 3, 4 or 5</number-eligible-discharge>
            <sample-size>0</sample-size>
            <sample-type>1</sample-type> (for Simple Random Sample)
</header>

Please contact HCAHPS Information and Technical Support by email at hcahps@hsag.com or by telephone at 1-888-884-4007 with any questions.

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HCAHPS V4.6 Submission of "Zero Cases"

Below please find instructions for uploading "Zero Case" information via QualityNet using the HCAHPS Data Form or the XML file format for July 1, 2023 patient discharges and forward.

HCAHPS Data Form

Please note the following: 

·  One header record must be completed for each month that an organization has "Zero Cases"

·  The NPI element is not required at this time, but may be entered if the information is available

·  For "survey mode," select "Mail only"

·  For "determination of service line," select "1 – V.41, V.40, V.39, V.38, V.37, V.36, V.35, V.34, V.33, V.32, V.31, V.30, V.29, V.28, V.27, V.26, or V.25 MS-DRG codes"

·  For "number eligible discharge," and "sample size" enter 0

·  For "sample type," select "Simple Random Sample"

XML File Format

Below is an example of the header record layout that must be submitted for each month that an organization has "Zero Cases."

<header>
            <provider-name>Some Hospital</provider-name>
            <provider-id>123456</provider-id>
            (NPI is not required)
            <discharge-yr>2023</discharge-yr>
            <discharge-month>7</discharge-month> (for July)
            <survey-mode>1</survey-mode> (for Mail only)
            <determination-of-service-line>1</determination-of-service-line> (for V.41, V.40, V.39, V.38, V.37, V.36, V.35, V.34, V.33, V.32, V.31, V.30, V.29, V.28, V.27, V.26, or V.25 MS-DRG codes)
            <number-eligible-discharge>enter actual count i.e. 0</number-eligible-discharge>
            <sample-size>0</sample-size>
            <sample-type>1</sample-type> (for Simple Random Sample)
</header>

Please contact HCAHPS Information and Technical Support by email at hcahps@hsag.com or by telephone at 1-888-884-4007 with any questions.

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