IPRO now has free training available for the nation's acute-care Prospective Payment System (PPS) hospitals on the "PEPPER" (Program for Evaluating Payment Patterns Electronic Report) electronic reporting tool from the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.
PEPPER provides summary statistics of administrative claims data on CMS target areas (areas likely to have payment errors due to billing, DRG/coding and/or admission necessity issues). Hospitals can use PEPPER to review their data for the current quarters and the previous three fiscal years for each of the areas targeted for improvement by CMS, and compare their performance to that of the other acute-care PPS hospitals within their state. They can also use the tool to compare their own data across years to identify significant changes in billing practices; pinpoint areas in need of auditing; identify potential DRG under- or over-coding problems; and identify target areas where length-of-stay is increasing. PEPPER can help hospitals achieve CMS's goal of achieving transformational change for the reduction of payment errors.
"PEPPER can provide hospitals with benchmarks on where they stand on compliance and audit risk, and this training will help in these risk reduction efforts," says Kathy Terry, Ph.D., Senior Director, Medicare/Federal Health Care Assessment at IPRO.
This training is provided at the direction of CMS through TMF Health Quality Institute (TMF), which is under contract with CMS as the Hospital Payment Monitoring Program (HPMP) Quality Improvement Organization Support Center, and is responsible for developing PEPPER. TMF subcontracted with IPRO, the New York-based Quality Improvement Organization (QIO), to conduct this training.
"Despite its potential to help with compliance and financial management practices, many hospitals underutilize PEPPER," says Dr. Terry. "Learning how to use PEPPER can seem difficult and our goal is to reduce the intimidation factor so that all appropriate hospitals can more easily access this innovative tool."
In the next few weeks, all acute-care PPS hospitals in the nation will receive a CD. The CD will contain a brief overview of the HPMP and PEPPER, a description and agenda for the training, a link to register for the training and a link to participate in an online community forum. The CD will also provide information on the targeted audiences within each hospital (e.g., compliance officers, utilization and health information management professionals, etc.) and how the data will be useful to each audience and to the hospital overall. The training sessions will be Web-based with audio accompaniment and will include a detailed review of the PEPPER report that is available to each acute-care PPS hospital. "Our plan is to begin general PEPPER training sessions in late October, after the latest PEPPER data release from TMF," says Dr. Terry. "There will be many general trainings, which are scheduled to run through early January 2006," she says. Following the general training sessions, IPRO will offer three advanced sessions. The sessions will cover advanced PEPPER interpretation, a DRG/coding topic area in detail, and a utilization topic area in detail. On completion of the program, one of the general sessions and all three advanced training sessions will be made available to all acute care hospitals on CD.
General sessions will cover the history, intent, use, navigation, meaning and implications of PEPPER. Advanced Webinar training will focus on more complex and specific issues and uses of PEPPER. Up to 200 hospitals will be able to participate in each of the sessions.
More information may also be found at http://www.pepperinfo.org or by contacting Dr. Kathy Terry at 516-209-5226.
With 20 years of experience in health care quality improvement and evaluation, IPRO holds major contracts with state and federal governments to review the cost and quality of services provided to Medicaid recipients, Medicare beneficiaries, and patients enrolled in managed care organizations, and to work with the health care community to improve those services. Based in Lake Success, New York, IPRO also holds contracts with private-sector clients to improve the quality of privately financed services.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.