Health Information Management

Use PEPPER reports to stay on top of common coding errors

HIM-HIPAA Insider, January 19, 2010

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CMS has once again contracted with the TMF Health Quality Institute to release Program for Evaluating Payment Patterns Electronic Reports (PEPPER) data in 2010. The electronic reports contain data for hospitals on MS-DRGs and discharges at high risk for payment errors.
HIM directors can evaluate their hospital’s potential risk for overcoding and unnecessary admissions by using PEPPER data. The reports help identify where facilities have outliers (i.e., above 90% or 75% or below the 10%) compared to other hospitals nationally and in their state. The statewide median is also included.
HIM directors can also use the information to educate physicians on issues relating to documentation, according to Susan Donahoo, RHIA, HIM director at Providence
Health Center in Waco, TX. Donahoo’s clinical documentation improvement (CDI) team uses the information for this purpose. If the hospital is high for sepsis, for example, the CDI team members educate their physicians on appropriate documentation in that area.
PEPPER reports tend to focus on specific MS-DRGs that have been problems in the past, as well as length of stay issues (e.g., one-day stays), says Judith A. Holloway, MPH, RHIA, CCS, CCS-P, quality director of HIM services at HFS Consultants in Oakland, CA.
These reports also help to identify potential risk management and case management issues, Holloway says.
Editor’s note: For more tips, view the February 2010 issue of Medical Records Briefing.

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