Administrative Memos

200211

FROM: Theodore O. Will, Chief Executive Officer
DATE: Dec 12, 2002
SUBJECT: An Introduction to The 7th Sow Hospital Payment Monitoring Program
IPRO CONTACTS:

Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, Extension 364

Upon implementation of the 7th SOW on August 1, 2002 and as described recently in IPRO Medicare Administrative Memoranda #2002-03/HPMP Administrative Memoranda #2002-10, the 6th SOW activities known as PEPP have evolved into the 7th SOW Hospital Payment Monitoring Program (HPMP). Program changes are similar to the evolution that occurred early on in the Health Care Quality Improvement Program, i.e., from state-based to nationally focused topic areas.

As required by the 7th SOW HPMP, IPRO will continue to monitor New York State hospital admission and coding patterns by conducting hospital profiling and trend monitoring/ target identification activities. However, unlike the 6th SOW, individual payment error improvement projects will not be initiated without the Center for Medicare & Medicaid Services' (CMS') approval. In addition, IPRO may be asked to participate in national projects based upon CMS claims data analysis of targeted areas. These target areas and associated claims data analyses will be shared with providers as directed by CMS.

In the interim, it is strongly suggested that hospitals continue to monitor IPRO 6th SOW focused DRGs (475, 416, 174 and 182) as well as sentinel utilization areas such as readmissions and short stays by using the tools available on the IPRO website (www.ipro.org). Monitoring tools may be accessed by typing "HPMP" in the Keyword search field on the IPRO homepage. Additional IPRO HPMP resources may also be found under "Resource Materials" as well as in the "Administrative Memoranda" section. Hospital compliance activities should not be limited to areas of IPRO and/or CMS focus. Hospitals must remain cognizant of and address payment error risk areas within their individual facilities.

IPRO's overall success with this task will again be evaluated based upon the New York state-specific rate of payment error reduction as measured by the results of the CMS-CDAC National Payment Error Surveillance sample. While IPRO will continue to collaborate with our hospital partners to identify improvement opportunities to reduce payment errors by sharing reports and available data, it is imperative that hospitals recognize the importance of continued vigilance in their own internal payment error monitoring activities as IPRO activities will be limited.

Should you have any questions in regard to the 7th SOW HPMP activities, please do not hesitate to contact Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment on extension 364.