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Published on: February 19, 2021
Report data identify risk areas for improper payments
1Executive Health Resources, Newtown Square, Pa., USA. drcorrato@ehrdocs.com
Summary
Hospitals can improve compliance by using Program for Evaluating Payment Patterns (PEPPER) reports to identify and address risks of improper payments. Analyzing PEPPER data helps pinpoint problem areas for targeted review and corrective action.
Area of Science:
- Healthcare Administration
- Medical Auditing
- Healthcare Compliance
Background:
- Improper payments pose a significant financial risk to hospitals.
- The Program for Evaluating Payment Patterns Report (PEPPER) provides data to assess payment accuracy.
- Effective utilization of PEPPER reports is crucial for compliance.
Purpose of the Study:
- To outline a strategic approach for hospitals to leverage PEPPER data.
- To enhance healthcare compliance and mitigate risks associated with improper payments.
- To guide hospitals in identifying and prioritizing areas of financial vulnerability.
Main Methods:
- Designate a PEPPER report monitor and download quarterly reports.
- Review reports to identify high-risk areas for improper payments.
- Prioritize risks using national, jurisdictional, and state comparisons.
- Conduct targeted case reviews in identified at-risk areas.
- Involve multidisciplinary teams (finance, legal, coding, etc.) in analysis and decision-making.
Main Results:
- Systematic review of PEPPER data enables proactive identification of compliance vulnerabilities.
- Prioritization based on comparative data focuses resources on highest-risk areas.
- Case reviews provide specific insights for process improvement or rebilling strategies.
- Collaborative expert input ensures comprehensive risk assessment and mitigation.
Conclusions:
- Hospitals can significantly enhance compliance efforts by systematically analyzing PEPPER reports.
- Proactive identification and targeted intervention in high-risk areas reduce improper payment risks.
- A multidisciplinary approach to PEPPER data analysis leads to more effective compliance strategies.
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