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Quality and performance data can be instrumental in improving healthcare, but it’s what you do with that data that matters. Data from the Program for Evaluating Payment Patterns Electronic Report (PEPPER) includes a wealth of information about reimbursement errors, but you should know how to put it to good use in your compliance program.
PEPPER is a benchmarking tool containing hospital-specific data for 14 Diagnosis Related Groups (DRGs) and discharges that have been identified as at high risk for payment errors. The data is provided free of charge by TMF Health Quality Institute, under contract with CMS and is intended to reduce Medicare fee-for-service improper payments. PEPPER used to be distributed to hospitals by their state Medicare Quality Improvement Organization (QIO), but QIOs are no longer involved in providing reports.
Data for different types of providers is released on different dates. TMF will release PEPPER data on several categories, including most hospitals, in April 2017.
(The release schedule and instructions for accessing your hospital’s PEPPER data can be found at this link: http://bit.ly/2m4JAsJ.
More information is available at https://www.pepperresources.org/.)
Make the Most of PEPPER
The PEPPER report is not well understood by some hospital professionals and is not used as much as it could be for quality improvement, says Deborah K. Hale, CCS, CCDS, president and CEO of Administrative Consultant Service, a consulting company based in Shawnee, OK, that assists hospitals with clinical documentation improvement and compliance.
PEPPER data has been a useful resource for several years at Bluegrass Care Navigators in Lexington, KY, which provides palliative, hospice, and other care. The health system has two provider identification numbers, so Bluegrass could pull PEPPER reports on both and compare their performance internally between facilities, as well as to national averages, says Eugenia Smither, RN, BS, CHC, CHP, CHE, corporate compliance officer and vice president of compliance and quality improvement.
When Bluegrass first began using PEPPER data, Smither and her colleagues first took time to validate the data, ensuring it provided an accurate picture of their performance. That is a good practice with any data report on your performance, Smither says, but after a few years of working with PEPPER, they have enough confidence in the report that they forgo that step.
Smither...