Under CMS contract requirements, Primaris’ HPMP project task is to measure, monitor, and reduce the incidence of improper fee-for-service inpatient payments, including errors in: DRG coding; provision of medically necessary services; and appropriateness of setting, billing, and prepayment denials. Reducing such errors will, in turn, protect the Medicare Trust Fund.
Primaris will analyze data received from CMS such as the Program for Evaluating Payment Patterns Electronic Reports (PEPPER), Medicare claims and Missouri payment errors to identify patterns and trends among Missouri hospitals. If problematic areas are identified, Primaris will collaborate with hospitals to identify causes and develop interventions to prevent these payment errors.
The long-term goal of HPMP is to help hospitals prevent payment errors through data analysis, focused audits, and the implementation of system changes that will ensure payment accuracy. Primaris provides data, education and assistance to hospitals to meet this goal.