PEPPER Available to Arkansas Long-Term Acute Care Hospitals (LTCHs)

To help meet our goal of assisting hospitals in their efforts to identify and prevent Medicare payment errors, AFMC’s Hospital Payment Monitoring Program (HPMP) is pleased to provide Medicare discharge data to Arkansas long-term acute care hospitals (LTCHs) via the Long-Term Acute Care Program for Evaluating Payment Patterns Electronic Report (LT PEPPER).  The LT PEPPER contains cumulative hospital-specific, Medicare inpatient Prospective Payment System (PPS) discharge data for five CMS-selected target areas—specific Diagnosis Related Groups (DRGs) and discharges that have been identified as at high risk for payment errors in the LTCH setting.  The LT PEPPERs can assist LTCHs in their efforts to monitor Medicare payment patterns in the five target areas over time.

High-risk target areas (effective April 2007)
The five LT PEPPER target areas for LTCHs are:
■ DRG 012 (degenerative nervous system disorders) with a LOS of less than 26 days
■ DRG 088 (chronic obstructive pulmonary disease) with a LOS of less than 26 days
■ DRG 249 (aftercare for musculoskeletal and connective tissue disorders) with a LOS of less than 26 days
■ Short Stays for six (6) at-risk DRGs:  DRGs 012, 088, 127 (heart failure and shock), 249, 462 (rehabilitation), and 466 (aftercare without history of malignancy as a secondary diagnosis) with a LOS less than 26 days
■ Excisional Debridement for 24 DRGs affected by procedure code 86.22 (excisional debridement), that have procedure code 86.22 coded on the claim.  The 24 DRGs are 007, 008, 040, 041, 063, 076, 077, 120, 170, 171, 201, 217, 263, 264, 265, 266, 287, 315, 344, 345, 365, 394, 440 and 486 (please refer to the LT PEPPER User’s Guide for DRG descriptions).

DRGs 012, 088, 249 and Short Stays were selected due to a high admission denial rate.  Excisional Debridement was selected due to a high percentage of coding or billing errors related to the use of procedure code 86.22.  Complete descriptions of the target areas can be found in the LT PEPPER User’s Guide, which can be accessed at www.hpmpresources.org (click on PEPPER and select Long-Term Care PEPPER User’s Guide).

Using LT PEPPER
An outlier, as used in the LT PEPPERs, is defined as a target area finding that is unusual relative to other long-term care hospitals nationwide.  PEPPER defines outliers as those findings that are at or above the statewide 75th percentile or at or below the statewide 10th percentile.  The PEPPERs identify outlier areas and help prioritize the hospital-specific findings to assist hospitals with their focused auditing and monitoring efforts.  Audit results can then be used to eliminate future payment errors and reduce Medicare compliance risks.

Top 20 DRGs/50 DRGs Worksheets
Two “Top DRGs” worksheets are also included in the LT PEPPERs.  The “Top 20” worksheet is hospital-specific and lists the top 20 DRGs for all discharges for your hospital in the current fiscal year, updated quarterly.  The “Nationwide Top 50” worksheet shows the top 50 DRGs for all discharges in the nation in the current fiscal year, updated quarterly.  The Top 20 and Nationwide Top 50 worksheets also include the number of short-stay outliers for each DRG, the percentage of discharges for each DRG that are short-stay outliers, and the average length of stay for discharges for each DRG.

Distribution of LT PEPPER
First disseminated in September 2006, AFMC distributes the LT PEPPERs by mail to Arkansas’ long-term care hospital administrators on a quarterly basis.  Each administrator receives two copies of the report on two separate CDs so that the report can be shared with individuals who work in positions relevant to the CMS target areas.  Administrators are encouraged to share the data with health information management, utilization review, case management, compliance and quality improvement staff and enlist their support in addressing payment patterns that appear to be unusual.

Additional Information
To find out more, please see the LT PEPPER User’s Guide and information on PEPPER training at www.hpmpresources.org.

Contact Person
For additional support, contact Suzanne Martin, HPMP Internal Review Coordinator/DRG Analyst, at 479-573-7772 or by email at smartin@arqio.sdps.org