What is PEPPER?
PEPPER is an electronic report, which contains statistics on hospital-specific Medicare claims data for target areas that are at high risk for payment errors as identified by the Centers for Medicare & Medicaid Services (CMS).
The target areas are
- One-day stays
- Hospital re-admissions
- Several DRGs (historically have been associated with payment errors)
The data contained in the reports are from the most recent three fiscal years, as well as the current fiscal year to date. The data is updated quarterly.
Why was PEPPER developed?
PEPPER was developed as part of CMS’s Hospital Payment Monitoring Program (HPMP). It is used to assist inpatient acute care prospective payment system hospitals with identifying and preventing payment errors. This report allows Qualis Health, your state’s Quality Improvement Organization (QIO), to provide you with comparative data that can be used to focus auditing and monitoring efforts to support the overall goal of HPMP, to reduce the Medicare payment error rate within each state and nationally.
How does PEPPER work?
PEPPER uses hospital-specific percentiles for each target area to determine "outlier values." The outlier values reveal how unusual a hospital’s findings are, relative to other hospitals in the state.
Positive outlier values:
- Indicate possible overcoding
- Questionable medical necessity of admission
Negative outlier values:
PEPPER sorts target areas in descending order by the outlier value times the number of discharges for the area. Note: this is by default.
The end result measure will capture both the unusualness and the scope of a possible problem. This allows the report to prioritize findings by potential importance and indicate where hospitals should focus their monitoring efforts.
PEPPER Users Guide:
- Assists hospitals with interpreting the data
- Suggests interventions for areas with potential payment errors
How can PEPPER benefit you?
- Prioritizes the findings to provide you with guidance on areas where your hospital may want to focus auditing and monitoring efforts
- Identifies areas of potential overcoding and undercoding
- Identifies areas that may be questionable in terms of medical necessity of admission
- Provides graphs comparing your hospital’s data to state level data
- This will assist in the identification of trends and outliers
