PEPPER: The Program for Evaluating Payment Patterns Electronic Report.
PEPPER provides summary statistics of administrative claims data on CMS target areas (areas likely to have payment errors due to billing, DRG/coding and/or admission necessity issues). Hospitals can use PEPPER to review their data for the current quarters and the previous three fiscal years for each of the areas targeted for improvement by CMS, and compare their performance to that of the other acute-care PPS hospitals within their state. They can also use the tool to compare their own data across years to identify significant changes in billing practices; pinpoint areas in need of auditing; identify potential DRG under- or over-coding problems; and identify target areas where length-of-stay is increasing. PEPPER can help hospitals achieve CMS's goal of achieving transformational change for the reduction of payment errors.
What is PEPPER?- PEPPER is a report that presents the pattern of payments made to your hospital from CMS in comparison with the rest of the acute care, prospective payment system (PPS), short stay, inpatient hospitals in your state.
- PEPPER is a Microsoft Excel file containing hospital-specific data for CMS target areas that are often associated with Medicare payment errors.
- PEPPER prioritizes findings to provide guidance on the areas in which a hospital may want to focus auditing and monitoring efforts.
- It identifies areas of potential over-coding and under-coding as well as areas that may be questionable in terms of medical necessity of admission.
- PEPPER is a report on recent payments made to your hospital so you can direct current and future efforts.
- Updated and released to your QIO quarterly, PEPPER presents the most recent and complete picture of hospitals' payment patterns over the preceding fiscal years.
- PEPPER ranks your hospital with all other acute care, inpatient hospitals in your state so that you can compare your hospital's Medicare payment history within the CMS target areas.
- PEPPER literally gives you the ability to clearly see payment trends across fiscal years by means of the graphical displays associated with each target area.
- PEPPER incorporates the sums and averages for length of stay and Medicare payments into the report in order to complete your hospital's payment pattern information.
PEPPER is a tool of the Hospital Payment Monitoring Program (HPMP).
The long-term goal of HPMP is to help inpatient prospective system hospitals monitor payment patterns by analyzing data, conducting focused audits, and implementing system changes to prevent payment errors.
Hospitals should be conducting regular audits to ensure that the medical necessity for admission and treatment is documented and that bills for Medicare services are correct.
CMS directed the TMF Health Quality Institute (TMF) to develop a tool that would help hospital prioritize their auditing tasks. The tool TMF developed is PEPPER.
PEPPER provides hospitals with data in a flexible format to help prioritize areas in which to focus auditing and monitoring efforts with the goal of identifying and preventing payment errors.
