PEPPER Reports Review: How YES Helps Clients Capitalize on their Healthcare Data

PEPPER Reports Review: How YES Helps Clients Capitalize on their Healthcare Data

Does your organization struggle to efficiently interpret and utilize data presented in the PEPPER (Program for Evaluating Payment Patterns Electronic Report) Reports? Then, read below for an in-depth review of the PEPPER metrics and how we help our clients capitalize on the data.

PEPPER Report Explained

PEPPER Reports are generated by CMS every quarter and submitted to healthcare providers (CMS, 2022). All types of healthcare providers – such as short- and long-term acute care hospitals, home health agencies, hospices, nursing facilities, and more – receive this quarterly report and data file.

The reports contain provider-specific Medicare encounter data on target areas vulnerable to improper payments. This report aims to eliminate the potential for Medicare fraud and abuse.

Reviewing the PEPPER metrics has numerous benefits, including identifying overpayments and underpayments, pinpointing possible overcoding or undercoding issues, and discovering problematic DRGs that need monitoring.

Analyzing PEPPER metrics is essential to maintaining compliance and diminishing the risks of Medicare fraud. But if your HIM department is not equipped to develop and apply strategies from the report effectively, your organization is missing out on opportunities for quality improvement.

Interpret & Develop Actionable Strategies from PEPPER Metrics

YES coding and auditing consultants are trained experts in examining PEPPER metrics. “Our clients provide us with their PEPPER Reports, and we review a random sampling of each of those target areas for that time frame that are either at/above the 80th percentile or at/below the 20th percentile in comparison to other short-term hospitals in the nation,” explains Karen Youmans, YES President and CEO. “Per CMS, the target areas that are either at/above the 80th percentile could indicate that there are coding errors that result in overcoding. The target areas that are either at/below the 20th percentile could indicate that there are coding errors that result in undercoding.”

In the below example, the highlighted target areas are the inpatient encounters our team reviews if the hospital has a “1” in that category:

pepper reports

If the target area has a “1,” our team reviews the random samplings of encounters and validates the DRG assignments against the documentation. If we disagree on the coding or DRG assignment, our consultants provide feedback on why we suggest a different code or DRG.

“Most of the target areas can be at/above the 80th percentile or at/below the 20th percentile due to variations in patient population, time of the year illnesses, and patient treatment needs for that quarter,” Youmans explains.

“Our work with the client’s PEPPER Report has positively impacted clients’ coding compliance and quality outcomes,” Elizabeth Kelly, Director, Auditing Services, says. “We’ve also been able to develop personalized education plans to help improve coders’ accuracy.”

Your healthcare organization stands to benefit from working with a trusted auditing partner like YES to analyze your PEPPER metrics. Reach out to our consultants to learn more about our audits and additional HIM services.

Karen Youmans, MPA, RHIA, CCS, President and CEO, co-authored this article with Amy Davis, RHIA, CDIP, Director, Inpatient Coding and CDI Services.

Amy Davis

Amy Davis, RHIA, CDIP – Director, Coding & CDI.
pepper reports

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