Administrative Memos

200702

FROM: Theodore O. Will, Chief Executive Officer
DATE: Mar 07, 2007
SUBJECT: Long Term Acute Care Hospital PEPPER Data Distribution
IPRO CONTACTS:

Kathy Terry, Ph.D., Sr. Director, Data Analysis & Evaluation, Medicare/Federal Health Care Assessment at 516-209-5562

As you are aware, IPRO, as the Quality Improvement Organization (QIO) for New York, distributes an administrative data tool designed to assist in identifying potential payment error issues for each of the Centers for Medicare & Medicaid Services (CMS) designated target areas for long-term acute care (LTAC) hospitals. These target areas focus on discharges at risk for payment errors due to incorrect coding-DRG assignment and/or potential medically unnecessary admissions.

This tool, called PEPPER (Program for Evaluating Payment Patterns Electronic Report), developed for QIO distribution by TMF Health Quality Institute (the Texas QIO), serving as the HPMP Quality Improvement Organization Support Center (QIOSC) for CMS, provides hospital-specific Medicare discharge data for fiscal years (FYs) 2003, 2004, 2005 and 2006 to date. These data provide detail on your hospital's standing with regard to other Long Term Acute Care (LTAC) hospitals nationally, dollars received as payment for each year for target areas, length of stay data, and more. These data have been provided on the enclosed CD-Rom and are presented in tabular and graphic formats which may be manipulated through the Excel tool in which they are distributed. A PEPPER Users Guide is also provided on the CD-Rom.

The Office of the Inspector General (OIG) published "The Office of Inspector General's Compliance Program Guidance for Hospitals" which encourages hospitals to develop and implement a compliance program. One aspect of a compliance program involves ensuring that charges for Medicare services are correctly documented and billed. To this end, hospitals should be conducting regular audits to ensure that charts document the need for the setting of care, including the treatment, and that the bills for services are correct. These PEPPER data disseminated by IPRO may be used to guide your auditing efforts.

A conference call and web training by IPRO focusing on interpretation and use of the LTAC PEPPER data was offered on June 28, 2006. Powerpoint slides from this session and additional training resources may be found via the "Long term Acute Care Hospitals - Resources" link at www.ipro.org/hpmp. Subsequent to this training session, LTAC hospitals provided feeback with regard to improvements that they would like to see incorporated into the Pepper reports. One such proposed revision focused on developing national comparative statistics. This data has been added beginning with the current Pepper report in the form of national percentiles (10th, 25th, median, 75th, and 90th) for each target area.

Additional resources for payment error monitoring and prevention available to LTAC hospitals are provided by the HPMP QIOSC at www.hpmpresources.org via entry of the characters "LTCH" in the search box at the top of the web page.

Should you have any questions or comments about PEPPER LTAC hospital reports and/or training, please contact Kathy Terry, Ph.D., Sr. Director, Data Analysis & Evaluation, Medicare/ Federal Health Care Assessment at 516-209-5562.