The Program for Evaluating Payment Patterns Electronic Report (PEPPER) has been updated to better reflect issues of most concern to quality professionals.
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 are provided free of charge by TMF Health Quality Institute, under contract with CMS, and is intended to reduce Medicare fee-for-service improper payments. (For more information on how to use PEPPER data for quality improvement, see “Good Use of PEPPER Data Makes a Difference in Quality,” HPR, April 2017, pp. 37-41.)
With changing concerns over what payments pose the greatest risk, PEPPER must be updated periodically, explains 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.
Hale notes that TMF Health Quality Institute recently provided an update to all short-term acute care inpatient prospective payment system hospitals that have a QualityNet Secure Portal account.
The update included this information:
- The “Same-day Stays for Medical DRGs” and “Same-day Stays for Surgical DRGs” target areas have been discontinued.
- The “One-day Stays for Medical DRGs” and “One-day Stays for Surgical DRGs” target areas have been revised to include same-day stays (where the patient was admitted and discharged on the same day) in addition to stays where the patient was admitted on one day and discharged on the next.
- The one-day stays and two-day stays target areas now exclude claims with occurrence span code 72 (which is used to identify outpatient time associated with an inpatient admission) with “through” date on or day prior to inpatient admission.
SOURCE
- Deborah K. Hale, CCS, CCDS, President and CEO, Administrative Consultant Service, Shawnee, OK. Telephone: (405) 878-0118. Email: [email protected].
