News: Latest PEPPER report available
The latest short-term Program for Evaluating Payment Patterns Electronic Report (PEPPER) is available for acute care hospitals nationwide, according to a September 1 announcement from CMS. The report includes statistics through the second quarter of fiscal year 2016.
PEPPER reports summarize hospital-specific data for MS-DRGs and discharges at risk for improper payments. It then compares your individual facility data to others in your state, and within fiscal intermediary/Medicare Administrative Contractor (MAC) region.
The agency distributes PEPPER reports via MyQualityNet to quality departments, finance departments, and other PEPPER recipients with a basic user account. CDI specialists can use the data available in PEPPER reports for benchmarking purposes, including clinical data and outcome measures, to compare their facility’s and providers’ rankings to other similar facilities and providers in their region.
CDI professionals can request access to the reports, which are usually available through an organization’s quality department or QualityNet administrator. CDI teams may also be able to obtain a basic user account—they should ask for “PEPPER recipient” and “file exchange and search” roles.
The intent of the PEPPER is to help hospitals proactively prevent inaccurate payments and identify potential documentation and coding problems, said Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI, director of enterprise solutions for ZirMed in a CDI Journal article, “Put PEPPER to proper use.” These problems are easier to track and resolve when PEPPER analysis is integrated into chart reviews.
Many of the PEPPER targets mirror those of CDI programs, including items such as respiratory failure and pneumonia, said Krauss. By proactively examining PEPPER data, facilities can identify trouble areas, examine the causes, and take steps to prevent future inaccuracies and denials. Since Medicare auditors often use the data , the PEPPER can help a CDI program identify what to go after in their own facility before auditors target it themselves.
PEPPER is a resource but must be used with critical thought, says Laurie Prescott, MSN, RN, CCDS, CDIP, CRC, CDI education director for ACDIS and HCPro in Middleton, Massachusetts.
“While it identifies areas of potential organizational vulnerabilities as well as areas of potential improvement need, one must first review the data as related to their organization, patient population and determine the significance,” she says. Some fluctuations and deviances may be perfectly appropriate considering your facility’s top diagnoses.
Visit PEPPERresources.org to access resources, including the user guide, recorded training sessions, frequently asked questions, and examples of how other hospitals are using PEPPER reports.