Quick links:  MS-DRG Codes | HCAHPS Service Line and V.34 APR-DRG Crosswalk | Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site | Data Submission Deadlines Through April 2025 | 25 Completed HCAHPS Surveys Required for Hospital HCAHPS Scores to be Publicly Reported on Hospital Compare | Submission of HCAHPS Administrative Data | Contacting QualityNet HelpDesk Regarding HCAHPS Data Submission Issues | 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.40 MS-DRG Codes Effective October 1, 2022 (09/26/2022)

CMS has adopted V.40 MS-DRG Codes effective October 1, 2022. Please click here for the Table of V.40 MS-DRG Codes and HCAHPS Service Line Categories.

V.39 MS-DRG Codes Effective October 1, 2021 (09/20/2021)

CMS has adopted V.39 MS-DRG Codes effective October 1, 2021. Please click here for the Table of V.39 MS-DRG Codes and HCAHPS Service Line Categories.

Previous MS-DRG Codes:

• 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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Point of Origin Code for Transfer from a Designated Disaster Alternate Care Site (07/31/2020)

Due to changes relative to the COVID-19 Public Health Emergency (PHE), the National Uniform Billing Committee (NUBC) created a new Point of Origin Code G. This code was effective August 3, 2020 and is defined as “Transfer from a Designated Disaster Alternative Care Site (ACS).”

For more information about these changes in coding point of admission, please see the MLN Matters document at https://www.cms.gov/files/document/MM11836.pdf. To learn more about ACS, visit the CMS Web site at https://www.cms.gov/files/document/covid-state-local-government-fact-sheet-hospital-alternate-care-sites.pdf.

Please note: Patients who transfer from a designated disaster Alternative Care Site (ACS) are eligible for the HCAHPS Survey if they meet the HCAHPS eligibility criteria and are not otherwise deemed ineligible. For information regarding HCAHPS eligibility criteria, please see the Sampling Protocol chapter of the most recent HCAHPS Quality Assurance Guidelines (QAG). The QAG is available for review and download by visiting the HCAHPS Web site at www.hcahpsonline.org and selecting the Quality Assurance navigation button.

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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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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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Contacting QualityNet HelpDesk Regarding HCAHPS Data Submission Issues (03/31/2016)

When contacting the QualityNet HelpDesk about issues related to HCAHPS data submission, the HCAHPS Project Team requests that the survey vendor or hospital copy the HCAHPS Project Team on these communications. Please “cc” HCAHPS Technical Assistance hcahps@hsag.com on data submission related emails sent to the QualityNet HelpDesk. Also be sure to provide HCAHPS Technical Assistance with any ticket number assigned by the QualityNet HelpDesk. In addition, if you contact the QualityNet HelpDesk via telephone, please send a follow-up email to the HCAHPS Technical Assistance as documentation of telephone conversation with QualityNet, and please include the ticket number.

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HCAHPS Public Reporting Periods for April 2022 Through October 2024 Have Been Updated (12/01/2022)

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 2024.

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):

• 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 2024 IPPS Final Rule Has Been Published (08/28/2023)

The FY 2024 IPPS Final Rule is now available on the Federal Register. 

The Final Rule and related tables are available at the following URL: 2023-16252.pdf (govinfo.gov)

Previous IPPS Final Rules:

• 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 Now Published (11/21/2018)

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

Combating the Opioid Crisis

In response to recommendations from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, to comply with the requirements of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271), and to avoid any potential unintended consequences, under the Hospital Inpatient Quality Reporting (IQR) Program, CMS is finalizing the proposal to update the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience of care survey measure by removing the three recently revised pain communication questions. The removal of these questions is effective with October 2019 discharges, for the FY 2021 payment determination and subsequent years, earlier than proposed. As a related modification, CMS will not publicly report the three revised Communication About Pain questions.

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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