Note from the speaker: Using PEPPER to unlock revenue integrity success

July 12, 2019
Medicare Web

by William L. Malm, ND, RN, CRCR, CMAS

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is key to revenue integrity success. Understanding its benefits and limits is important for any successful revenue integrity program. Too often, organizations assume PEPPER is of value only to compliance or case management, leaving other departments that could benefit from the data out of the loop. But PEPPER isn’t just useful for identifying hotspots for compliance to investigate or case management to focus on—it’s critical data that should be shared to other revenue cycle stakeholders such as revenue integrity, internal audit, physician advisors, coding, and individual service lines.

But unlocking the revenue integrity value of PEPPER requires thoughtful analysis of the data and solid processes to transform data into concrete action. At the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16 in Orlando, I’ll help attendees decode the processes and best practices that put PEPPER to work for revenue integrity during my session, “PEPPER: An Integral Tool for Revenue Integrity.” I will provide an overview of PEPPER, training materials, and the different types of PEPPER reports. I’ll explain why using PEPPER as a concurrent rather than a retroactive tool is the key to success, as well as how the upper and lower percentiles are calculated and why they are important. I’ll also provide real-life, field-tested tips on how to use PEPPER to create other internal auditing methodologies. And, of course, I’ll discuss how to properly deploy the resources to put your plans into action: the people, processes, and technology that will deliver the best results.

I’ve spoken many times at RIS, and what keeps me coming back are the high quality of the education and the networking opportunities. Last year, there were a number of attendees in my session that created an impromptu networking and discussion period around PEPPER and how they use it in their facilities. This sharing resulted in uncovering several new ways PEPPER was helpful to other facilities. These are the types of connections and conversations that can’t be reproduced in other formats and that are so valuable to an organization’s success. Attendees return from RIS with fresh ideas and insights, new methods to tackle stubborn problems, and a strong network of colleagues across the country they can turn to for advice.

In previous years, some of the most valuable information I gained put a spotlight on the failures that result from siloed revenue cycle management. The ideas and sessions at RIS that promote a culture of interconnectedness and interdepartmental collaboration were among the most informative sessions I attended.

RIS is truly a can’t-miss opportunity. Each year the program becomes more mature and diverse, taking in all aspects of revenue integrity. The speakers are all industry thought leaders, making it a must-attend conference. Click here to view the full agenda. I’m looking forward to seeing you there.

Editor’s note: Malm is a managing consultant at Berkley Research Group, Health Performance Improvement Group.

Register for the 2019 Revenue Integrity Symposium before August 17 to get the $100 early bird discount. NAHRI members get an additional $100 discount. Need help getting approval to attend? Click here to download a justification letter proposal that you can use to gain administrative support and approval for attending.

Related Topics: 
Auditing and monitoring