A Special Message to Hospitals From the Centers for Medicare & Medicaid Services (CMS)
CMS would like to thank hospitals for their hard work in identifying and implementing process improvements to prevent and correct inpatient Medicare payment errors. These activities ensure that the Medicare Trust Fund is used appropriately to provide Medicare beneficiaries with necessary medical care and services.
There are many aspects to the payment process, including: accuracy of data entry and claim submission, appropriate medical record documentation, determination of the appropriate setting of care, and accurate coding of diagnoses and procedures. When all of these components work correctly, payment errors are reduced.
While progress in reducing payment errors has been made in recent years, additional improvements can only be achieved with your assistance. The current short-term acute care inpatient hospital net payment error rate is 3.7 percent, representing $3.5 billion in Medicare dollars. We ask hospitals for a continued commitment to improve processes to further reduce payment errors. Using tools such as the Program for Evaluating Payment Patterns Electronic Report (PEPPER) can support hospital compliance, monitoring, and improvement efforts. The Quality Improvement Organization (QIO) in each state is available to offer experience, expertise, and resources to support these activities.
Hospitals are encouraged to contact their QIO for further assistance in using PEPPER and to participate in Hospital Payment Monitoring Program (HPMP) projects and other quality improvement activities. Working together, we can achieve improvements to reduce payment errors and protect the Medicare Trust Fund.
