Welcome to HPMP Resources
HPMPResources.org was developed to provide information, tools, and data to hospitals and health care providers related to payment error prevention. This Web site was developed and maintained by TMF Health Quality Institute, under contract with the Centers for Medicare & Medicaid Services (CMS) as the Hospital Payment Monitoring Program (HPMP) Quality Improvement Support Center (QIOSC). This contract ended January 31, 2009; as of February 1, 2009 this Web site will not be updated.
Please read the HPMP Resources Web site disclaimer.
Program for Evaluating Payment Patterns Electronic Report (PEPPER)
PEPPERs were distributed by TMF to all hospitals in the nation that had a MyQualityNet account in early November 2008 and late January 2009. Unfortunately, there is no support available to assist hospitals with PEPPER other than this Web site. For more on PEPPER click here.
Hospital Payment Monitoring Program (HPMP)
HPMP was a nationwide effort by the Centers for Medicare & Medicaid Services (CMS), an agency of the Department of Health and Human Services, to protect the Medicare trust fund by ensuring that Medicare pays for services that are reasonable and medically necessary. Effective with the CMS 9th Scope of Work, beginning August 1, 2008, HPMP is not a responsibility of the QIO contract with CMS. Responsibilities for conducting HPMP have been transferred to other contractors; please see CMS' "Inpatient Prospective Payment System Hospital and Long Term Care Hospital Review and Measurement Fact Sheet", available on the CMS Web site here (PDF).
The long-term goal of HPMP was to help inpatient prospective system hospitals prevent payment
errors by analyzing data, conducting focused audits, and implementing system changes to ensure payment accuracy. Quality Improvement Organizations (QIOs) provided data, education, and assistance to hospitals to meet this goal. The purpose of HPMP was to measure, monitor, and reduce the incidence of Medicare payment errors for short-term and long-term inpatient prospective payment system hospitals. HPMP was implemented by QIOs through their contract with CMS.
HPMP measured and monitored Medicare payment errors through a system designed to estimate payment errors. Each month, a random sample of 62 discharges per state and Puerto Rico (42 for Alaska) was selected. The final sample was conducted for December 2007 discharges. The associated medical records were requested from hospitals by a Clinical Data Abstraction Center (CDAC). The CDAC screened the medical record for accuracy of DRG assignment and appropriateness of admission, using InterQual screening criteria. Records failing this screen were forwarded to the appropriate QIO for full case review. Please see the QIO manual (click to view the manual) for a description of the QIO case review process. The results of this case review were used to estimate payment error rates for the state and for the nation, and were also used to track and trend payment errors by error type (DRG error, unnecessary admission, billing error) as well as by DRG. Data from this process were included in the annual Improper Medicare Fee-For-Service Payments Report (click to view the report).