HH Grouper Program

80 – HH Grouper Program (Rev. 11644, Issued: 10-13-22, Effective: 04-01-23, Implementation: 04-03-23) The Home Health Resource Group (HHRG) used to pay home health services billed on TOB 032x are determined by the HH Grouper program. HHRGs are represented on claims in the form of HIPPS codes. Like the HH Pricer, the HH Grouper is a module within Medicare claims processing systems. The HHA sends a HIPPS code on the claim, using revenue code 0023. Medicare systems combine claim data and OASIS data and send the data to the HH Grouper to determine the HIPPS code used for payment. The HIPPS code from the Grouper replaces the provider-submitted HIPPS code on the claim and is then sent to the HH Pricer for payment calculations. Medicare claims processing systems send an input record to Grouper for all claims and most adjustments. Medical review or other program integrity contractor adjustments are not sent to the Grouper. The Grouper returns an output record to the shared systems whenever an input record is sent. No part of the Grouper logic is required to be incorporated into an HHA’s billing system in order to bill Medicare, unless the HHA chooses to do so to assist their accounts receivable functions. The following is presented for A/B MACs (HHH) and as information for the HHAs, in order to help HHAs understand how their HH claims are processed.