In this 8th SOW, CMS is directing the QIOs to continue the Hospital Payment Monitoring Program (HPMP). The purpose of HPMP 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 denial.
The basis of HPMP is statutory and regulatory. Section 1154 of the Social Security Act statutorily mandates utilization review of professional services to the requirements of Subsection (d) (i.e., those of short-term acute care fee-for-service hospitals, for which payment is made). In accordance with 42 CFR ยง412.508 (a), QIO review shall include short-term and long term-term acute care services. For fee-for-service inpatient hospital claims (paid and denied), HPMP fulfills the CMS requirement to comply with the Improper Payment Information Act of 2002 (Public Law No. 107-300)
