Case managers have already become familiar with the Medicare Recovery Audit Program. In January, however, government Recovery Auditors began focusing on new territory: Medicaid claims.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER), distributed either quarterly or annually depending on the type of facility, contains large amounts of data on how a facility compares to others in the same state, the same jurisdiction (i.e., the same Medicare Administrative Contractor), and nationwide in terms of coding and medical necessity target areas. (Find out more at www.pepperresources.org.)PEPPER identifies when facilities are outliers in their reporting of multiple risk areas. For coding, those areas are:
