Administrative Memos

200118

FROM: Theodore O. Will, Chief Executive Officer
DATE: Aug 20, 2001
SUBJECT: Reminder In Regard To PEPP Processes And Remeasurement Plans
IPRO CONTACTS:

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

As you are aware, in the Medicare Payment Error Prevention Program (PEPP), IPRO is required to work with all acute care Prospective Payment System (PPS) hospitals within New York State to identify and reduce payment errors in Medicare inpatient claims. As directed by CMS (formerly HCFA), PROs are to focus PEPP projects on both unnecessary admissions and DRG coding errors.

Since implementing PEPP in August 1999, IPRO has initiated multiple DRG and unnecessary admission projects (e.g., DRG 475-Respiratory Distress with Ventilator Support, Short Stays associated with ICD-9-CM Procedure 99.25-Injection/Infusion of Chemotherapeutic Substance, etc.). Concurrently, IPRO monitors Medicare claims data for new topic areas.

IPRO's PEPP projects follow a baseline-interevene-remeasure approach. (For more specific details about our methodology please refer to Medicare Administrative Memorandum #1999-08/PEPP Data Analysis Plan and Medicare Administrative Memorandum #2000-03/PEPP Administrative Memorandum #2000-05: PEPP Intervention Plan.) Following identification of baseline rates in each topic area of focus, IPRO disseminates aggregate baseline data reports along with hospital-specific reports, where applicable. These reports are distributed to all hospitals in NYS. Additional follow-up occurs with specific outlier hospitals identified to have payment error issues. Subsequent to the distribution of each project's baseline report and after any follow-up interventions, IPRO remeasures the project topic area to verify that hospital improvements have occurred. If no improvements are identified, submission of a written performance improvement plan will be required. At this time IPRO has begun remeasuring project topic DRG 475. We will shortly begin remeasuring other topic areas (e.g., DRG 416-Septicemia; Short Stays and ICD-9-CM Procedure Code 99.29-Injection/ Infusion of Prophylactic Substances) as well as continuing to conduct baseline abstraction for new projects.

Should you have any questions in regard to this memorandum, please feel free to contact Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, Extension 364.