The electronic Program for Evaluating Payment Patterns Electronic Report (PEPPER) contains data for hospitals on MS-DRGs and discharges at high risk for payment errors. Per the opening paragraph of the 2010 PEPPER User’s Guide:
As part of a compliance program, a hospital should conduct regular audits to ensure charges for Medicare services are correctly documented and billed. PEPPER can help guide the hospital’s auditing and monitoring activities.
HIM staff members have a lot on their plates right now, but one more looming deadline needs to be on their radar—the Federal Trade Commission (FTC) will begin to enforce its Red Flags Rule June 1. Hospitals must have an identity theft prevention program in place by that date.
Recovery audit contractor (RAC) activity is picking up, but many healthcare providers are still waiting to see whether their preparations have paid off, according to a January survey of more than 400 healthcare providers conducted by MRB. Eighteen percent of survey respondents had received medical record requests (i.e., additional documentation requests) as of the time of the survey. Only 8% of providers received RAC denials.
As recovery audit contractors (RAC) begin to roll out complex reviews and request medical record documentation, compliant coding will continue to take center stage. And although correct coding is vital, sequencing codes is equally important because it affects MS-DRG assignment and payment.
CMS has once again contracted with the TMF Health Quality Institute to release Program for Evaluating Payment Patterns Electronic Reports (PEPPER) data in 2010.
