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The Payment Error Prevention Program (PEPP): reducing Medicare payment errors in prospective payment system hospitals
D A Bitonte1, P Curry, P Butler
1Payment Error Prevention Program, Ohio KePRO, Seven Hills, Ohio, USA.
Abstract:
Peer Review Organizations (PROs) are charged by the Health Care Financing Administration (HCFA) to assist in protecting the integrity and solvency of the Medicare program. Recent audits of the Medicare program from the Office of Inspector General (OIG) revealed that more than $12 billion Medicare dollars in 1998 were spent in improper payments, with more than 25% attributed to prospective payment system (PPS) hospitals. The Payment Error Prevention Program (PEPP) is an initiative designed by HCFA in 1999 to assist PROs in meeting the goal of reducing payment errors in PPS hospitals. PEPP is implemented through the development of quality improvement (QI) methodologies. These projects are designed to achieve measurable improvements in processes and outcomes of payment errors. PEPP works to reduce payment errors at PPS hospitals through cooperative efforts with Ohio agencies and licensing boards, federal law enforcement organizations, HCFA contractors, hospital medical staffs, and medical and osteopathic associations.
Insights
The Payment Error Prevention Program (PEPP) was developed by HCFA to help Peer Review Organizations (PROs) reduce Medicare payment errors in PPS hospitals. This initiative uses quality improvement methods to achieve measurable results in preventing improper payments.
Area of Science:
- Healthcare Administration
- Health Services Research
- Quality Improvement
Background:
- The Medicare program faces significant financial losses due to improper payments, with a substantial portion attributed to Prospective Payment System (PPS) hospitals.
- Audits by the Office of Inspector General (OIG) highlighted over $12 billion in improper Medicare payments in 1998.
Purpose of the Study:
- To introduce the Payment Error Prevention Program (PEPP) as a HCFA initiative to aid PROs in reducing payment errors.
- To outline the methodology of PEPP in addressing improper payments within PPS hospitals.
Main Methods:
- Implementation of quality improvement (QI) methodologies tailored to reduce payment errors.
- Collaborative efforts involving state agencies, federal law enforcement, HCFA contractors, and medical associations.
Main Results:
- PEPP aims to achieve measurable improvements in processes and outcomes related to payment errors.
- The program focuses on cooperative strategies to minimize financial waste in the Medicare system.
Conclusions:
- PEPP is a key initiative for enhancing the integrity and solvency of the Medicare program.
- Quality improvement methodologies are central to reducing improper payments in PPS hospitals.
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