Journal excerpt: Pass the PEPPER

No, we don’t mean the common table spice. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is distributed by TMF Health Quality Institute under contract with CMS and summarizes facility-specific data statistics for Medicare services that may be at risk for improper payments.

“Auditors look at and read your PEPPER,” said Kurt Hopfensperger, MD, JD, on a June 27 HCPro webinar regarding PEPPER. “And, even if they may not read the actual PEPPER for your facility, they have access to the data used for developing the PEPPER” and can target their reviews/audits. Basically, the PEPPER takes a facility’s MS-DRG claims data that is at high risk for payment errors due to coding, documentation, and/or medical necessity issues, and compares that data to other facilities within the specific Medicare Administrative Contractor (MAC) region, as well as to facilities nationwide. (For more information about MAC jurisdictions, read the September/ October issue of CDI Journal.)

The reports basically give a detailed peek at where your facility may be vulnerable. Why wouldn’t CDI programs make use of that, especially when CMS itself encourages facilities to use the data to support internal auditing and monitoring?

To find out how to use your PEPPER, read the rest of the CDI Journal article, “Pass the PEPPER: Benchmark CDI efforts and defend against denials.”

Editor’s note: To read the rest of this article, click here. To read the November/December issue in its entirety, click here.