Revenue Cycle

What color is your PEPPER?

Strategies for Health Care Compliance, November 1, 2011

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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.

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