Hospital Payment Monitoring Program
The Hospital Payment Monitoring Program (HPMP) is a nationwide effort by the Centers for Medicare & Medicaid Services(CMS) to protect the Medicare trust fund by ensuring that Medicare pays for services that are reasonable and medically necessary.
The purpose of HPMP for the 8th Statement Of Work (SOW) remains to measure, monitor, and reduce the incidence of improper fee-for-service inpatient payments. However, there will be additional activities for the program to promote transformational change related to the reduction of payment errors.
- KFMC is required to conduct an HPMP project (a focused intervention involving a specific area prone to payment errors and/or specific hospitals) in Kansas. KFMC will be working with hospitals in this effort. The purpose of HPMP projects is to reduce and prevent payment errors, as well as to gain knowledge that can be shared to support HPMP efforts.
- Long term acute care hospitals (LTCHs) will become a focus for reducing Medicare payment errors, as KFMC will now monitor data for LTCHs in Kansas and may choose to conduct an HPMP project involving LTCHs.
CMS will continue to pull a random sample of Medicare discharges each month throughout the next three years. Review outcomes from this random sample will continue to be used to monitor payment error trends on a state and national basis.
KFMC will continue to receive quarterly administrative data from CMS for target areas identified as at risk for payment errors that will assist in their efforts to work with hospitals to identify and prevent payment errors. These target areas are as follows:
- DRG 014 (intracranial hemorrhage and stroke with infarct
- DRG 079 (respiratory infections and inflammations age > 17 with cc)
- DRG 416 (septicemia age >17)
- Readmissions within 7 days of discharge to the same or to another acute care hospital
- DRG 243 (medical back problems)
- DRG 089 (simple pneumonia and pleurisy age >17 with cc)
- Proportion of discharges billed to the higher-weighted DRG in a CC pair to all discharges in the CC pair
- Three-day qualifying skilled nursing facility admissions
- One-day stays excluding transfers
- One-day stays for:
- DRG 127 (heart failure and shock)
- DRG 143 (chest pain)
- DRGs 182/183 (esophagitis, gastroenteritis, and miscellaneous digestive disorders ages > 17 with and without CC)
- DRGs 296/297 (nutritional and miscellaneous metabolic disorders age >17 with and without CC)
Hospitals can obtain hospital-specific and statewide comparative data in the above noted target areas from KFMC.