News: PEPPER data published

CMS recently released its Short-Term (ST) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through the third quarter of the fiscal year 2016 for hospitals nationwide.

The PEPPER allows hospitals to compare Medicare billing practices against those of other hospitals in the same state, in the same Medicare administrative contractor (MAC) or fiscal intermediary (FI) jurisdiction, and against national statistics. These comparisons enable a hospital to determine if it is an outlier, significantly differing from other ST acute care hospitals. Once such outliers are identified, CDI programs can perform an audit of related charts to ensure physician documentation appropriately captures the necessary information and, if opportunities for improvement are identified, provide targeted educational outreach and queries regarding the concern.

PEPPER data released to each hospital is facility specific, focusing on inpatient discharges in areas potentially at risk for improper Medicare payments. 

The data in each free report is presented in tabular form, as well as in graphs, that depict the hospital’s target area percentages over time. The data also includes reports on the hospital’s top medical and surgical DRGs for one-day stays.  All of the data tables, graphs, and reports in the PEPPER are designed to assist the hospital in identifying potential overpayments as well as potential underpayments.

It is distributed by TMF^® Health Quality Institute under contract with CMS. Visit PEPPERresources.org to access resources, including the user guide, recorded training sessions, information about QualityNet accounts, frequently asked questions, and examples of how other hospitals are using PEPPER.

Editor’s Note: To learn how to use PEPPER at your facility listen to the April 26, 2016 webinar “PEPPER: Reduce Risk and Improve Revenue Integrity.” ACDIS members can read more in the CDI Journal article “Put PEPPER to proper use.”