Supporting Information For PEPPER

• Special Message from CMS
• CMS Target Areas
• The Big Picture: HPMP
• Simplify Your Efforts: PEPPER
• Intended Audience

• Recorded Trainings
  • General
  • Advanced Conceptual
  • Coding DRG's and CC Pairs
  • Utilization: One-day stays excluding transfers
• CEU Credit Availability
• PEPPER Main Site

HPMP The Big Picture (History & Where We are Today)

History

A key initiative of the Centers for Medicare & Medicaid Services (CMS), the Hospital Payment Monitoring Program (HPMP) is part of a nationwide effort to protect the integrity of the Medicare program by ensuring that only reasonable and medically necessary services, that are appropriately documented in a medical record, are paid for.

The HPMP has its roots in the Medicare Quality Improvement Organization Program's 6th Scope of Work (beginning in August 1999). Then known as the Payment Error Prevention Program (PEPP), it was established to help the nearly 4,000 short-term, acute-care Prospective Payment System (PPS) hospitals reduce inpatient services billing and payment errors. The program was fine-tuned, and its name changed to HPMP, during the 7th Scope of Work (August 2002) and continues into the current 8th Scope of Work (beginning in August 2005).

HPMP efforts are led by the nation's 53 Medicare Quality Improvement Organizations (QIOs), under contract with CMS. QIOs, PPS hospitals, and other health care stakeholders work together to identify payment errors and reduce their frequency through data analysis, educational initiatives, and the development and implementation of systemic improvements.

Where we are today

Payment errors have long been a focus of CMS efforts since they represent incorrect payments made from the Medicare Trust Fund. Specifically, the efforts focus on inpatient care issues such as documentation that fails to support the need for the billed setting of care. There are also instances of DRG billings that are not supported in the medical record. At times there is poor documentation and/or assumptive coding that occurs when a coder tries to interpret what a physician meant to state, versus what is actually written and documented in the patient chart.

Payment errors are monitored by CMS through a statewide random sample of billed Medicare claims each month. These results are then aggregated to provide state and national error rates. The error rates within each state have varied greatly since this monitoring program began back in 1999. The national error rate, however, has failed to decrease significantly over time leading to a need for greater efforts from all hospitals to reduce these errors. PEPPER can guide each hospital in compliance efforts at identifying and reducing problematic target areas.