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Hospital CEOs and Administrators will have quick and easy access to:
- Tables and graphs to examine performance over time
- Hospital-specific data and aggregate statewide comparative claims data for
target areas
- Administrative data comparison spanning time periods to identify changes
in billing practices and monies received for CMS target areas
- Hospitals' overall outlier status for each of CMS' target areas
(i.e., areas determined to have increased payment error risk)
Chief Financial Officers will have quick and easy access to:
- Data across multiple fiscal years depicting trending
- Information on DRGs with the greatest volume of billed cases
- Tables and graphs to compare hospital data to statewide data
- Most recent quarters’ payments compared to payments in previous time
periods
- Resource expenditures related to payment received (i.e., length of stay (LOS)
data)
Compliance Officers will have quick and easy access to:
- Hospital-specific data for target areas identified by CMS as at
high risk for payment errors
- Data that may indicate whether the hospital is at risk for being targeted
for audits
- Data that identify areas of potential overpayments and underpayments
- Statistics on Medicare discharge data for review
- Guiding, prioritizing, auditing, and monitoring data to assist in reducing
compliance risk
- PEPPER data, tables, and graphs for hospital comparisons within the state
Utilization Review Director and Staff will have quick and easy access to
data that:
- Identify areas that may be questionable in terms of medical necessity
of admission
- Identify target areas where length of stay is increasing
- Assist in the identification of areas in need of further review to determine
whether the admission was medically necessary, procedure or treatment was
performed in appropriate setting
HIM Directors and Staff will have quick and easy access to:
- Data that identify potential DRG overcoding and undercoding
- Data that identify DRGs that are problematic on which the hospital may want
to focus auditing and monitoring
- PEPPER reports for presentation to administration, physicians and for educational
training activities
- Hospital-specific outlier target areas for hospital payment monitoring
and auditing
- DRGs with largest volume of discharges
