Program for Evaluating Payment Patterns Electronic Reports (PEPPERs)The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is an electronic data report containing hospital-specific data for 13 (formerly 14) target areas [specific Diagnosis Related Groups (DRGs) and discharges that have been identified as at high risk for payment errors].The target areas have been selected by CMS because a national analysis of payment errors identified that they were high in either dollars in error or proportion of payment errors. The current PEPPER target areas are:
The PEPPERs also include two additional worksheets. The first, titled "One-Day Stay Top 20 DRGs" lists the top 20 DRGs for one-day stays for the specific time period (excluding patient discharge status codes of 02, 07, and 20) for the individual hospital. The second worksheet shows the Statewide Top 20 DRGs for One-Day Stay Discharges for the specific time period. The PEPPER data represent Medicare inpatient PPS discharges. The source of data reported in the PEPPERs is Medicare inpatient PPS discharge data. The PEPPERs include the following reports:Data tables: PEPPERs provide data tables that include data for three full fiscal years and the current fiscal year to date. Measures included in each data table include the total number of discharges for the target area (target area discharge count, which is the numerator), the denominator count of discharges, the proportion of these two figures and average length of stay and Medicare payment data. Graphs: PEPPER graphs provide a visual representation of the proportion for each target area over time. Four data points are represented: the previous three full fiscal years and the current fiscal year to date. The graphs can assist in the identification of significant changes from one year to the next, which could be a result of changes in the medical staff, coding staff, utilization review processes, or hospital services. Hospitals are encouraged to identify root causes of major changes to ensure that payment errors are prevented. Compare Worksheet: The Compare Worksheet assists hospitals with prioritizing areas for auditing and monitoring by using two factors: 1) the number of discharges for an area, and 2) the hospital's "outlier value" for that area, which is a measure of how unusual the finding for the hospital is relative to all PPS hospitals in the state. A complete description of how the outlier value is calculated is outlined in the PEPPER Users Guide that is provided with each PEPPERs. Generally, positive outlier value findings identify possible over coding errors, while negative values generally identify possible under coding errors. By default, the Compare Worksheet is sorted in descending order by the outlier value times the number of discharges for each outlier target area. This resulting measure captures both the unusualness and the scope of a possible problem and is the recommended priority order for a hospital to focus monitoring efforts. Example of the PEPPER Compare Worksheet How Can Hospitals use the PEPPERs? "The Office of Inspector General's Compliance Program Guidance for Hospitals," (http://oig.hhs.gov/authorities/docs/cpghosp.pdf), released in 1998, encourages hospitals to develop and implement a compliance program. One aspect of a compliance program involves ensuring that charges for Medicare services are correctly documented and billed. Hospitals should conduct regular audits to ensure that the medical necessity for admission and treatment is documented and that bills for Medicare services are correct. Hospitals can use the PEPPERs to guide their auditing and monitoring activities related to the identification and prevention of payment errors. PEPPERs provide statewide comparative data that enable hospitals to identify where they differ from their peers with regards to the above-noted high-risk areas. The data can assist hospitals in identifying both potential overpayments as well as potential underpayments. A User’s Guide is provided with each PEPPER version. The User’s Guide gives detailed information on interpreting the PEPPER findings. Distribution of the PEPPERs by AFMC AFMC sent the first PEPPERs out to all Arkansas PPS hospitals in paper version (version 5.0) on March 28, 2004. All subsequent reports have been and will be sent to hospitals via the Quality Net Exchange on a quarterly basis. 2007-2008 schedule for posting PEPPERs on the Quality Net Exchange: · Version 17.0 - February 15, 2007 Assistance with PEPPERsFor assistance using or receiving the PEPPERs please contact: Karen Gabel, RHIA HPMP Manager Email: mailto:kgabel@arqio.sdps.org Phone: 479-573-7714 D.J. Blaylock Quality Net Exchange Administrator Email: dblaylock@arqio.sdps.org Phone: 479-573-7666 |
HPMPProjectsTargeted Paired DRGs: 182/183 & 296/297 ResourcesPhysician Documentation and Inpatient Prospective Payment System (IPPS) Reimbursement Manual Short Term Acute Care Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) Long Term Acute Care Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) Publications |
