Qualidigm - HPMP

Hospital Payment Monitoring Program (HPMP)

Project Overview
What's New
Tools & Resources
FAQs
Our Partners
Project Team
Events

Project Overview

Imagine a health care system where every person receives the right care every time, and where staff and providers have the tools and resources to deliver that care. Qualidigm and the Centers for Medicare & Medicaid Services (CMS) are dedicated to realizing this vision.

Qualidigm, Connecticut's Quality Improvement Organization (QIO), is assisting hospitals to identify the root causes of payment errors related to coding, billing and utilization. As your QIO, we are committed to helping hospitals to reduce their payment error rate.

Qualidigm is working with Connecticut hospitals to measure, monitor and reduce the incidence of Medicare payment errors for inpatient stays in acute care hospitals.

Project Goals:

Reduce Connecticut's payment error rate using quality improvement techniques.
Identify root causes of errors and implement quality improvement methodologies to reduce the likelihood of future errors.

Active participation in HPMP will:

Enable providers to proactively reduce and eliminate payment errors.
Assist providers in meeting compliance guidelines for coding, billing and utilization.
Assist providers in identifying areas of undercoding or inappropriate coding that result in incorrect reimbursement.

Qualidigm's Approach:

Our staff works with hospitals to use both data collection and case review (DRG, utilization and quality of care) to reduce the number of payment errors by:

Partnership Building

Conducting collaborative workshops and presenting information related to compliance and preventing hospital payment errors to the Connecticut Hospital Association, its membership and other hospitals.

Performance Feedback

Providing the Program for Evaluating Payment Patterns Electronic Report (PEPPER) tool which provides acute care Prospective Payment System (PPS) hospitals in Connecticut with aggregate statistics of administrative claims data on CMS target areas (areas likely to have payment errors due to billing, DRG coding and/or admission necessity issues).
Helping hospitals to use the PEPPER tool to review their current and past performance data, and compare their performance to blinded data from other acute care hospitals within Connecticut.

Quality Improvement Training and Support

Promoting improvement interventions such as educational sessions in coding documentation, recommended levels of care for inpatient admissions, compliance and other activities to reduce payment errors.

Marketing and Communications

Recognizing outstanding quality improvement efforts through the Qualidigm Quality Awards program.

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What's New

Attention Medical Staff Offices!!! Qualidigm has sent Connecticut hospitals their Physician Acknowledgment Monitoring lists via the QualityNet website. Please make sure you review, update and return your facility’s list to Qualidigm as soon as possible. Questions regarding this process can be sent to Karen Reinoso.

Reducing Admission Denials Through the Promotion of Hospital Observation Status

Educational Workshop Materials

Final Report October 2007

Reducing Admission Denials Through the Promotion of Hospital Observation Status (Oct. 2007)

3Q FY 2007 PEPPER Reports were uploaded to QualityNet on Monday 11/27/07. To review an explanation of changes to ST PEPPER click here. To view your report, contact your facility's QualityNet administrator, Karen Eckert or Jared Cowden at Qualidigm.

Reminder – providers should submit their ACTIVITY log as soon as possible in order to receive their next PEPPER update. Thank you to those who have already submitted!

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Tools & Resources

HPMPResources.org
Use this first-of-its-kind national clearinghouse for one-stop shopping of tools and information related to hospital payment error prevention.

HPMP Compliance Workbook
This workbook provides crucial guidance, suggestions and tools for hospitals seeking to develop, update or strengthen their compliance programs, particularly for areas monitored by the Centers for Medicare & Medicaid Services (CMS).

The HPMP Compliance Workbook has been created to assist hospitals in meeting the goals of the Hospital Payment Monitoring Program. This workbook was designed to give practical guidance and provide helpful tools related to identifying and improving hospital compliance program structures and processes that contribute to payment error outcomes. This workbook focuses on issues related to inpatient hospital payment error monitoring and prevention.

HPMP Compliance Workbook (PDF)
HPMP Compliance Workbook (Word)
All Appendices in one PDF file

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FAQs

What are hospitals expected to do with PEPPER information?
Hospitals should perform internal monitoring and audits in the CMS target areas that are at or above the 75th percentile, or at or under the 10th percentile. The interventions suggested in the PEPPER User’s Guide may be used as a reference for the specific target area.

What benefits will hospitals obtain from using PEPPER?
PEPPER will assist hospitals in identifying potential payment error areas and initiating corrective measures. It can serve as a guide for internal audits and monitoring efforts required as part of the hospital’s compliance program. It provides specific hospital statistics with respect to the 14 target areas that were selected by the Centers for Medicare & Medicaid Services (CMS) and that have been under the scrutiny of the Office of the Inspector General (OIG) for potential payment errors. As an additional benefit, hospitals may use these reports to make presentations in their administrative meetings and educational activities.

How should the PEPPER information be shared?
PEPPER report information will be helpful to hospital staff and management in the areas of compliance, utilization management, finance, billing and health information management.