Q&A: Using your PEPPER for CDI
Q: Should CDI have access to the Program for Evaluating Payment Patterns Electronic Report (PEPPER)?
A: My short answer would be yes, absolutely. The information provided could be extremely helpful in performing a CDI specialist’s duties.
The PEPPER provides information specific to your facility regarding potential vulnerabilities in payments which could result in claims denials and problems with payments recoupment. Potential underpayments are identified in red, and could identify areas where documentation may be lacking. Overpayments are identified in green, and could identify areas where reviews should be done to ensure that the documentation in the medical record is accurate and appropriately supports the code assignment used for billing of a claim.
Failure to review PEPPER data can be interpreted as a reckless disregard or deliberate ignorance in a False Claims Act case.
If you’d like to learn more about PEPPER, denials prevention, and CDI, check out this article from the November/December edition of the CDI Journal.
The data provided in the PEPPER is based on previously paid Medicare claims. It’s free to access and it’s distributed to numerous types of facilities such as short-term acute care hospitals, critical access hospitals, and inpatient psychiatric facilities through QualityNet. A complete list of facilities can be found at this website.
The problem I hear about most often is the CDI staff usually have no idea who receives the information at their facility, what it says, or how to read it. My suggestion would be to do some investigating. Find out who is receiving the data and ask if they can share it with you. The official PEPPER website will provide you with some additional information, training, and support.
Editor’s note: Sharme Brodie RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.