st pepper users guide, third edition – pepper resources.pdfVIP

Short-term Acute Care Program for Evaluating Payment Patterns Electronic Report User’s Guide Seventh Edition Prepared by Short-term Acute Care Program for Evaluating Payment Patterns Electronic Report User’s Guide Seventh Edition Prepared by TMF Health Quality Institute Introduction 3 What Is PEPPER? 3 ST PEPPER CMS Target Areas 4 How Hospitals Can Use PEPPER Data 10 Installation 18 System Requirements 18 Technical Assistance 18 Using PEPPER 19 Target Area Data Tables 19 Target Area Graphs 19 Compare Worksheet20 Hospital Top Medical DRGs for One-Day Stay Discharges Report21 Hospital Top Surgical DRGs for One-Day Stay Discharges Report 21 Jurisdiction Top Medical DRGs for One-Day Stay Discharges Report21 Jurisdiction Top Surgical DRGs for One-Day Stay Discharges Report 21 Glossary 22 Appendix 1: DRG Listing for the Medical DRGs with CC or MCC Target Area 26 Appendix 2: DRG Listing for the Surgical DRGs with CC or MCC Target Area 33 Appendix 3: DRGs Affected by Procedure Code 86.22 41 ST PEPPER User’s Guide, Seventh Edition 2 Introduction What Is PEPPER? The Office of Inspector General encourages hospitals to develop and implement a compliance program to protect their operations from fraud and abuse.1,2 As part of a compliance program, a hospital should conduct regular audits to ensure charges for Medicare services are correctly documented and billed. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) can help guide the hospital’s auditing and monitoring activities. PEPPER is an electronic data report that contains a single hospital’s claims data statistics for Medicare- se