HPMS PI Portal Enhancements for Fraud, Waste, and Abuse Reporting
Relevant to: PDP, Audit Protocol, PACE
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
Disclaimer: The content provided on this site is a summary for informational purposes only, and Grane PBM, Inc. assumes no liability for any errors or omissions in the site’s content. The information does not constitute legal or regulatory advice or replace the original CMS memo. Readers are advised to consult the CMS memo in its entirety and to verify information independently before making any decisions based on this information.
Click here to read the complete memo from CMS.
Introduction
In an effort to strengthen the integrity of the Health Plan Management System (HPMS), the Centers for Medicare & Medicaid Services (CMS) announces enhancements to the Fraud, Waste, and Abuse (FWA) Reporting Module. These updates, set to launch on November 15, 2024, introduce new functionalities and streamlined processes to improve plan submissions and increase reporting effectiveness. Stay informed with the detailed, updated user guide available post-release within the HPMS PI Portal.
Key Dates and Deadlines
- Memo Date: October 21, 2024
- Enhancement Release Date: November 15, 2024
- PSP Results Email Notification Intervals:
- Immediately after submission
- 6 months after submission
- 1 year after submission
PACE Compliance
This memo is relevant to PACE programs because it details important enhancements to the Health Plan Management System (HPMS) Program Integrity (PI) Portal, specifically targeting improved mechanisms for Fraud, Waste, and Abuse (FWA) reporting. PACE organizations, along with other Medicare-related entities, are required to adhere to these new reporting enhancements to ensure compliance.
Key compliance requirements for PACE programs include the following:
- New questions have been introduced for Referrals of Substantiated and Suspicious (RSS) FWA and Payment Suspensions of Pharmacies submissions. PACE programs will need to respond accurately to these questions to maintain compliance.
- If a “Yes” response is given to the question on using HPMS AICE-FWA for reporting, a series of follow-up questions must be answered regarding whether the issue pertains to a provider, pharmacy, or both, the project model utilized, and any actions taken.
- PACE organizations must accurately report whether a provider is in-network or out-of-network, and supply further details if actions such as payment suspensions occur.
- The enhancements include a requirement to report on whether payment suspensions have been lifted and if providers remain in the network, ensuring transparency and accountability.
- Pace programs should actively monitor the status of their submissions, including any “In Progress” reports, and ensure they receive and acknowledge notification emails regarding comments posted in the I-MEDIC system.
- Some reports now have collapsed sections upon initial data entry which require attention to ensure complete and accurate submissions, as well as timely updates post-submission.
- A new email notification system is in place for Payment Suspension results, necessitating that PACE programs address status updates promptly to avoid repeated notifications.
PACE programs must review the updated user guide in the HPMS PI Portal post-release to understand all procedures and to ensure that their reporting aligns with the new enhancements. Non-compliance with these enhancements could lead to sanctions or penalties within the CMS framework.
Required Actions
The memo details the enhancements to the HPMS PI Portal: FWA Reporting module. CMS will release these on the evening of November 15, 2024, and includes new questions and functionalities for plan organizations. Here are potential actions related to the memo:
1. Review the updated user guide within the HPMS PI Portal post-release to understand the new features and functionalities fully, especially regarding RSS and PSP submissions.
2. Prepare to update processes or systems to accommodate the newly introduced dropdowns and response options associated with FWA and PSP submissions, including handling the new notification emails.
3. Train relevant staff and stakeholders on the updated functionalities and reporting requirements to ensure accurate data entry and compliance with the new reporting guidelines.
FAQs
- “What enhancements are being made to the HPMS PI Portal’s FWA Reporting module?”
- “When will the enhanced FWA Reporting module be released?”
- “What new questions will be included in the FWA Reporting module enhancements?”
- “How will the new RSS submission process work?”
- “Where can I find the updated user guide for the HPMS PI Portal enhancements?”