Support your revenue integrity department with PEPPER

Improper payments can easily occur due to errors in billing, coding, or medical necessity. As such, it’s important to have a program in place to help you identify and prevent improper payments.

The Program for Evaluating Payment Patterns Electronic Report (PEPPER), can we be used to help your facility monitor compliance and auditing activities. Released quarterly for acute-care hospitals, the report offers feedback to providers of improper payment.

“PEPPER can be a proactive instrument that benefits you and your facility to create sustainable changes and sustainable processes,” says William L. Malm, ND, RN, CRCR, CMAS, in the recent HCPro webinar, “Contemporary Approaches to PEPPER: Support Revenue Integrity and Reduce Risk”.

To ensure that revenue integrity is integrated in high-risk operations, he advises using PEPPER proactively. One way to do this is to examine front-end auditing for your departments, Malm says. One area of focus is defibrillator implants, which are a risk for acute care facilities. “The Comprehensive Error Rate Testing contractor identified a high error rate (58%) for defibrillator implants (DRGs 226-227) in the Supplementary Appendices for the Medicare Fee-for-Service 2014 Improper Payments Report,” according to PEPPER Resources.

To manage the risk, Malm advises using PEPPER to do testing. “This may be a key practice indicator for a clinical performance area using mathematics,” he adds. Taking the time to do testing can have a huge impact on improving the revenue integrity of your facility.

For more information on these key issues, read Revenue Integrity Insider, a newsletter from the National Association of Healthcare Revenue Integrity.