Grouper Links Assessment and Payment

10.1.10.1 - Grouper Links Assessment and Payment (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) Position #1 Position #2 Position #3 Position #4 Position #5 Source & Timing Clinical Group Functional Level Co- Morbidity Placeholder E - MS Rehab F – Behavioral Health G – MMTA Surgical Aftercare H – MMTA Cardiac & Circulatory I – MMTA Endocrine J – MMTA GI/GU K – MMTA Infectious Disease L – MMTA Respiratory The home health Grouper software is incorporated in Medicare claims processing systems. The Grouper uses claims data and OASIS data from the CMS quality data repository to assign the HIPPS code used for payment on the claim. In the event of a temporary failure of the file transfer process that connects the claims and quality data systems, the MACs may resubmit claims to the quality system to ensure matching OASIS data is found. This action may occur in response to notification from CMS or at the discretion of the MAC.