Frequently Asked Questions (FAQs)
*HPMP -- formerly known as PEPP
Go to FAQs for HPMP
Go to FAQs for HCQIP
Q: Will Task 1 charts be subject to HPMP case review?
A: No. These medical records will only be the subject of case review if the reviewer identifies a quality problem while doing the data abstraction.
Q: Anytime a chart is requested by a clinical data abstraction center (CDAC), is the chart automatically sent in for HPMP review?
A: No. CDAC requests charts for a number of different reasons. Not all charts will be automatically reviewed for payment errors. Only charts requested for HPMP will be reviewed for payment error.
Q: Will physician reviewers be from all over Ohio or just from the Cleveland area?
A: Physician reviewers will be from all over Ohio. The requirements to be a physician reviewer include the following: (1) A valid medical license to practice in Ohio; (2) Board certification; and (3) In active practice in the state of Ohio for more than 20 hours per week. They also have to be on an Ohio hospital medical staff and have admitting privileges at a Medicare approved hospital.
Q: Will HPMP be monitoring ambulatory cases?
A: HPMP will be involved with the cases of patients admitted to prospective payment hospitals. It will not monitor cases from physicians’ offices or other ambulatory settings.
Q: Does the twelve cents per page reimbursement from the Centers for Medicare & Medicaid services (CMS) for copying medical records and postage apply to only HPMP or to activities in Mandatory Review?
A: The reimbursement applies to any medical records Ohio KePRO requests from prospective payment hospitals.
Q: Does HPMP review only fee-for-service admissions or are managed care admissions reviewed as well?
A: HPMP is only reviewing fee-for-service Medicare admissions to prospective payment hospitals.
Q: Will Ohio KePRO refer an individual case to the Office of the Inspector General (OIG) or will it look for patterns before it makes referrals?
A: Ohio KePRO contractually must refer an individual case to the OIG if there is a reason to believe there is intent to defraud on the part of the provider. Ohio KePRO anticipates that referrals of individual cases will be rare.
Under HPMP, single cases may well trigger a wider examination to determine whether a payment error exists. If a pattern is detected, education would typically be the first remedy Ohio KePRO employs. Ohio KePRO would refer a pattern of payment errors to the OIG only when educational efforts have failed or if the provider failed to comply with any obligation in a substantial number of admissions, or grossly and flagrantly violated any obligation in one or more instances.
Q: How can providers be involved in developing criteria for defining a payment error?
A: Ohio KePRO is required to engage the hospital community in these type of discussions. The rules as to what Medicare pays for are defined in law and regulation. However, the nature of evidence of a payment error, such as what constitutes documentation for specific issues, and the appropriate ways to interpret patterns resulting from analysis of paid claims, do represent opportunities for providers to offer information and advice to Ohio KePRO. Providers can and should play a continuing role in dialogue with Ohio KePRO, discussing how it can interpret the information at hand. As Ohio KePRO and providers examine how the criteria are applied in specific cases, they will occasionally identify areas where the criteria are vague or need greater precision and clarification.
Q: Can collaborators get benchmark data on other clinical indicators - other than those from CMS - from the Clinical Data Abstraction Center (CDAC) system?
A: The number of cases abstracted by the CDAC for each national project is too small to determine provider performance. By working with us, we can access and provide for you aggregate project-specific data for the nation and Ohio. All information about a specific entity is confidential. However, the data can be broken out by peer group, or other aggregate presentation.
Q: Do HMOs need to have a memorandum of agreement (MOA) and provider manual?
A: Yes, the MOA's for the HMOs were developed and sent to each Medicare Advantage Plan. We also developed the provider manual for the Medicare Advantage Plans and sent it to them.
Q: Our hospitals participate in the National Registry of Myocardial Infarction (NRMI-3) for monitoring acute myocardial infarction (AMI). Can these data be used instead of Ohio KePRO’s chart abstractions?
A: We may be able to use the NRMI-3 database for the project if we are able to identify the Medicare patients, the indicators are identical, and other pertinent issues are addressed.
Q: Does Medicare require hospitals to participate in HCQIP?
A: Participation in the HCQIP is voluntary. We encourage all providers to participate in the HCQIP projects because of the assistance with data collection and analysis, intervention, and developing improvement plans Ohio KePRO can give to their quality improvement projects. Further, participation can lead to positive marketing, improved service, lowered costs for your institution or organization, and help hospitals meet JCAHO’s quality regulations.
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