Revenue Cycle

Tip: Interpreting PEPPER reports

Medicare Update for CAHs, July 27, 2011

Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports became available to CAHs this past April. When it comes to interpreting and identifying certain aspects of the report, you’ll notice numbers and percentages that may look unfamiliar. The numbers in the percentage represent two distinct items:

The numerator represents the number of problem discharges (Discharges where MS-DRGs or DRGs have had medical necessity issues (such as back pain or chest pain.) The denominator represents the number of discharges for the identified DRG, or just all discharges. (Discharges for DRG target areas and the DRGs to which these have historically been billed in error.)

This tip was adapted from the HCPro audio conference “PEPPER for Critical Access Hospitals: Identify Your Audit Risk.”

Most Popular