Welcome to HPMP Resources 

HPMPResources.org was developed to provide information, tools, and data to hospitals and health care providers related to payment error prevention. This web site is maintained by TMF Health Quality Institute, under contract with CMS as the HPMP Quality Improvement Organization Support Center (QIOSC).

We welcome comments and feedback regarding this site.

If you require assistance with this site, please contact the HPMP QIOSC, TMF Health Quality Institute, at 1-888-691-9167 or by e-mail at help@hpmpresources.org.

Please read the HPMP Resources Web site disclaimer.

Hospital Payment Monitoring Program (HPMP)

The Hospital Payment Monitoring Program (HPMP) is a nationwide effort by the Centers for Medicare & Medicaid Services (CMS), an agency of the Department of Health and Human Services, to protect the Medicare trust fund by ensuring that Medicare pays for services that are reasonable and medically necessary.

The long-term goal of HPMP (formerly known as the Payment Error Prevention Program) is to help inpatient prospective system hospitals prevent payment errors by analyzing data, conducting focused audits, and implementing system changes to ensure payment accuracy. Quality Improvement Organizations (QIOs) provide data, education, and assistance to hospitals to meet this goal. The purpose of HPMP is to measure, monitor, and reduce the incidence of Medicare payment errors for short-term and long-term inpatient prospective payment system hospitals. HPMP is implemented by QIOs through their contract with CMS (click to locate your QIO).

HPMP measures and monitors Medicare payment errors through a system designed to estimate payment errors.  Each month, a random sample of 62 discharges per state and Puerto Rico (42 for Alaska) is selected and the associated medical records are requested by a Clinical Data Abstraction Center (CDAC). The CDAC requests the medical records from hospitals and screens the medical record for accuracy of DRG assignment and appropriateness of admission, using InterQual screening criteria. Records failing this screen are forwarded to the appropriate QIO for full case review.  Please see the QIO manual (click to view the manual) for a description of the QIO case review process. The results of this case review are used to estimate payment error rates for the state and for the nation, and are also used to track and trend payment errors by error type (DRG error, unnecessary admission, billing error) as well as by DRG. Data from this process are included in the annual Improper Medicare Fee-For-Service Payments Report (Click to view the report).