Health Information Management

What color is your PEPPER?

HIM-HIPAA Insider, September 27, 2011

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The Program for Evaluating Payment Patterns Electronic Report (PEPPER), distributed either quarterly or annually depending on the type of facility, contains large amounts of data on how a facility compares to others in the same state, the same jurisdiction (i.e., the same Medicare Administrative Contractor), and nationwide in terms of coding and medical necessity target areas. (Find out more at PEPPER identifies when facilities are outliers in their reporting of multiple risk areas. 

To compare organizations of varying size and varying volumes of patients, each organization's data is translated into a percentage of cases that fall within each target area. The volume of cases within an error-prone MS-DRG is divided by the volume of discharges for the target MS-DRG plus all MS-DRGs to which the claim is often reassigned. The resulting percentage is compared to the percentages of other facilities, producing a ranking system. Facilities that fall at the lower end of the bell curve (i.e., below the 20th percentile) are reported in italicized green font, while those at the high end (i.e., above the 80th percentile) are in bold red font.
The data is color-coded, so you can easily spot potential problem areas even if you're pressed for time, according to Cheryl Ericson, MS, RN, manager of clinical documentation integrity and utilization review at the Medical University of South Carolina.
Editor’s note: Click here to read the entire article in the September issue of Medical Records Briefing.

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