Health Information Management

Tip: Use PEPPER reports to search for CDI targets

CDI Strategies, June 10, 2010

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The Program for Evaluating Payment Patterns Electronic Report (PEPPER) includes a wealth of information regarding MS-DRG outliers that might otherwise go completely unnoticed. That’s what happened at Baptist Memorial Health Care Corp. until the 15-hospital health system began analyzing its PEPPER data in 2003, says Kathy Graham, RN, MSHA, CPHQ, ACM, system director of case management and regulatory affairs specialist at the facility.

The data they gleaned helped Baptist Memorial monitor MS-DRG volume, enhanced coding compliance, highlighted medical necessity issues, and illuminated target areas for clinical documentation improvement.
 
PEPPER is a free, facility-specific resource which identifies outliers in areas considered at risk for payment errors due to improper coding or billing, including certain conditions or types of hospital stay, says Kimberly Hrehor, MHA, RHIA, FACHE, CHC, project director at TMF Health Quality Institute in Austin, TX. TMF Health Quality Institute in Austin, TX, develops and distributes PEPPER data in conjunction with CMS.
Examples of PEPPER outliers frequently match areas that are targets for CDI too such as:
  • Respiratory infections 
  • Simple pneumonia 
  • Septicemia 
  • Medical MS-DRGs with CC or MCC 
  • One-day stays for medical MS-DRGs 
And these, in-turn, often find their way onto the audit lists of Medicaid Integrity Contractors as well as Recovery Audit Contractors and others.
 
Many facility compliance or HIM departments currently cull through this report for applicable data, so CDI managers should seek out those who’ve worked with PEPPER reports to determine how they can use them to enhance their daily chart review activities.
 
Editor’s note: This article was adapted from the May edition of Briefings on Coding Compliance. Listen to the live audio conference PEPPER 2010: Analyze the New Report to Improve Coding and Quality  on Tuesday, June 15, 1-2:30 p.m., EST. The program features Robert M. Tippens, director of Quality Improvement and Medical Staff Services, East Texas Medical Center, Tyler, TX, and Mark Miani, MD, senior medical advisor, Expert Advisory Services for Executive Health Resources (EHR) in Newtown Square, PA.



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