FROM: Theodore O. Will, Chief Executive Officer
DATE: Feb 23, 2000
SUBJECT: Records Requested By The Clinical Data Abstraction Center (CDAC) For The Payment Error Prevention Program (PEPP)
IPRO CONTACTS:
Andrea Goldstein, Vice President, Health Care Assessment, ext. 364
As part of the Payment Error Prevention Program (PEPP), the Health Care Financing Administration (HCFA) plans to measure the statewide payment error rate throughout the country. FMAS Corporation, Clinical Data Abstraction Center (FMAS/CDAC) is responsible for conducting the PEPP baseline and re-measurement sample for New York. It is important to understand that all records requested for the (PEPP) must be received and reviewed. If a requested record is not received, then the documentation necessary to establish payment is missing and a payment error has occurred. Therefore, IPRO must issue a technical denial for all requested records not received by FMAS/CDAC within the required timeframe.
The national PEPP baseline sample consists of a fiscal year 1998 DRG validation sample (approximately 30,000 records) and an additional supplemental sample (approximately 30,000 records), if needed, to obtain a total of approximately 1,100 cases per state.
FMAS/CDAC will make the initial request for the medical record as well as perform the screening review. Hospitals are required to deliver the requested medical record to FMAS/CDAC within 30 days of their request. FMAS/CDAC will generate a reminder within this 30-day period. When the record is 60 days overdue (more than 90 days from the date of the request), FMAS/CDAC marks the record as cancelled (not received). A technical denial must then be issued by IPRO.
FMAS/CDAC will begin reviewing records for the re-measurement sample beginning in February of 2000. For New York, this sample will include all discharges occurring on or after October 1, 1999 through July 31, 2002. FMAS/CDAC will request ninety-three (93) records per month. Please note that for this re-measurement sample, FMAS/CDAC will mark a record as cancelled (not received) 45 days after the date for the request.
As noted above, IPRO will issue a technical denial letter for all requested records which are not received by FMAS/CDAC within the required timeframes. Please remember, this includes notifying the Fiscal Intermediary (FI) of the appropriate adjustment. However, FMAS/CDAC will forward any records received after the past due date to IPRO for review as a re-opened technical denial.
Should you have any questions in regard to this memorandum, please feel free to contact Andrea Goldstein, Vice President, Health Care Assessment.