Hospital Payment Monitoring Program (HPMP)

Effective Aug. 1, 2008, with the beginning of their 9th Scope of Work, Quality Improvement Organizations (QIOs) will no longer be responsible for implementing the Hospital Payment Monitoring Program (HPMP).

The purpose of HPMP was to measure, monitor and reduce the incidence of improper fee-for-service inpatient acute care Medicare payments. QIOs will no longer be responsible for these functions and funding for QIO assistance related to these responsibilities will cease. These responsibilities are being transferred to other entities. Hospitals should be aware that support and education provided by QIOs related to payment error reduction will no longer be available. Hospitals may wish to contact the following organizations for questions previously directed to QIOs related to compliance or payment error reduction activities:

• Compliance-related questions: Health Care Compliance Association
• Billing questions: Fiscal Intermediary or Medicare Administrative Contractor

Many QIOs also distributed quarterly hospital-specific comparative data reports (the Program for Evaluating Payment Patterns Electronic Report, or PEPPER). Although not required to do so, QIOs will be able to distribute PEPPERs through the January 2009 data release. A metric for readmissions within 30 days has recently been added to the PEPPERs to aid QIOs in efforts related to this 9th Scope of Work area. It has not been determined at this time whether PEPPERs will be generated after January 2009. The tools and resources posted at www.hpmpresources.org will be available through January 2009.

For error rate calculation, the final sample under HPMP was selected in February 2008; October 2007 discharges were sampled. Sampling after this date was discontinued as it is not possible to utilize the samples toward the final error estimate that HPMP will contribute, the agency estimate to be released in November 2008. Inpatient records for calculating the national fee-for-service Medicare error rate will be sampled under the Comprehensive Error Rate Testing (CERT) program beginning in April 2008. More information on the CERT program is located at http://www.cms.hhs.gov/cert.

QIOs will continue to perform other statutory and regulatory mandated review activities and quality improvement as described in the 9th Scope of Work.