Administrative Memos

200801

FROM: Theodore O. Will, Chief Executive Officer
DATE: Apr 14, 2008
SUBJECT: Release of National Payment Error Cause Analysis and Compliance Workbook
IPRO CONTACTS:

Kathy Terry, Ph.D., Senior Director, Data Analysis & Evaluation, Medicare/Federal Healthcare Assessment, 516-209-5562

Release of National Payment Error Cause Analysis and Compliance Workbook

The (CMS) recently released the national fiscal year (FY) 2006 Payment Error Cause Analysis. This comparative information may be useful in your ongoing hospital compliance efforts.

The national data indicated a slight increase in the net and gross error rates from FY 2005 to 2006 (i.e., from 3.1% to 3.6% and from 4.8% to 4.9%, respectively). As can be seen in Figure 1, admission denials comprise the greatest portion of the payment errors. In fact, while diagnosis-related group (DRG) errors decreased slightly, admission denials increased from FY 2005. Admission denials are denied hospitalizations for patients not requiring the inpatient level of care, or the admission was denied as a prohibited action due to circumvention of the prospective payment system.

See Figure 1

The top five (5) admission denied DRGs are shown in Figure 2, below. Complete national data may be found at http://www.hpmpresources.org (the Hospital Payment Monitoring Program (HPMP) Quality Improvement Organization Support Center (QIOSC) website). DRG-specific denial patterns for both admission and DRG/coding denials are available on the site for this year as well as the prior fiscal year.

See Figure 2

HPMP Compliance Workbook

The HPMP QIOSC recently released updates to the HPMP Compliance Workbook. The updated workbook may be found at http://www.hpmpresources.org/Portals/1/Tools/HPMPCompWkbk_03-2008.pdf . Be sure to download your updated version.

Should you have any questions about these data or updates, please contact Dr. Kathy Terry, Senior Director, Data Analysis & Evaluation at 516-209-5562 or via email at kterry@nyqio.sdps.org.