HPMP
Under contract with the Centers for Medicare & Medicaid Services (CMS), Masspro facilitates the Hospital Payment Monitoring Program (HPMP). This program assists hospitals to identify the root causes of problematic utilization, coding, and quality issues, and promotes the implementation of improvement activities that utilize collaborative and educational approaches.
The program encourages more specific and relevant provider documentation for greater accuracy in the coding process and appropriate diagnosis related group (DRG) assignment, with the overarching goal of increasing the accuracy of payments made by the Medicare program. An important aspect of this project is that it produces outcomes that align with health care quality improvement.
The PEPPER (Program for Evaluating Payment Patterns Electronic Report) tool provides acute-care Prospective Payment System (PPS) hospitals in Massachusetts 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).
Hospitals can use PEPPER to review their data for the current quarters and the previous three fiscal years, and compare their performance to blinded data from other acute-care PPS hospitals within Massachusetts. A hospital’s data can also be compared across years to identify significant changes in billing practices, pinpoint areas in need of auditing, detect potential DRG under- or over-coding problems, and identify target areas where length-of-stay is increasing.
|
