Helping Hospitals Improve Payment Accuracy

The Hospital Payment Monitoring Program (HPMP) is a nationwide program initiated by the Centers for Medicare & Medicaid Services (CMS) to protect the Medicare trust fund.  The goal of HPMP is to help inpatient prospective payment system (PPS) hospitals prevent payment errors through data analysis, focused audits, and the implementation of system changes that will ensure payment accuracy. As the Medicare Quality Improvement Organization, Oklahoma Foundation for Medical Quality provides data, education and assistance to hospitals to meet this goal.

HPMP works under the assumption that payment errors are most often caused by simple mistakes. Payment errors include unnecessary admissions for which a hospital received payment, insufficient or incorrect documentation, and coding and billing errors. These errors may result in underpayment or overpayment to a hospital.

We perform data analysis and case review to identify potential patterns of payment errors within a single hospital and across Oklahoma. We look for billing compliance, coding accuracy, and quality concerns. If a pattern of errors is discovered, OFMQ can work with a hospital to identify the causes and implement continuing improvement methods to reduce the likelihood of future errors.

Benefits of HPMP participation:

• Enables providers to proactively reduce and eliminate payment errors rather than responding to case review determinations.
• Assists providers in meeting compliance guidelines.
• Assists providers, free of charge, in identifying areas of incorrect coding that results in incorrect reimbursement.