ED. NOTE: Anissa Fabrizio, RHIA, CCS, is the Administrative Director of Health Information Management and Patient Access for St. Anthony Central Hospital in Denver, Colorado.

On Oct. 25, the PEPPER reports for the third quarter of fiscal year 2010 were released. Each quarter, our coding manager performs an analysis of our facility data, looking at any trends that can be identified along with any internal opportunities for improvement we may have.

For the last two quarters, our data was evaluated for the same eight target areas of concern and compared to three different groups:

• Jurisdiction = all hospitals within our fiscal intermediary
• State = all Colorado hospitals within our fiscal intermediary
• National  = all hospitals in the U.S.

The target areas were chosen to identify potential coding or billing errors. Some target areas involve DRGs that have the potential to be under-coded or up-coded. Other target areas include sources of potential errors in patient status designation, readmissions or misuse of the three-day SNF requirement.

The figures in the PEPPER reports represent percentages listed in the form of number of discharges for a target area related to the target areas themselves. The facility figures are compared to the jurisdiction, state and national percentiles.

The percentage is highlighted in red when the facility figure is significantly higher than the jurisdiction’s figure (at or above the 80^th percentile). It is highlighted in green when the facility figure is significantly lower than the jurisdiction’s figure (at or below the 20^th percentile).

When analyzing your facility’s PEPPER data, consider the following:

• The severity-of-illness level within the patient population at the facility – does it correspond with the data in the PEPPER reports?
• Examine specialty services and programs within your facility, such as stroke certification.
• Compare data from one quarter to the next. If there are significant changes evident, determine if there is a correlation with business practices to account for them, such as an elimination of a service area, an addition of a service area, staff turnover in coding or changes in billing or coding.
• Does your facility have a clinical documentation improvement program?  If so, to what degree is this program contributing to documentation specificity and assisting the data capture and coding accuracy?
• What has recent audited data shown, and how do the audit results compare to the PEPPER reports?

Sample auditing of the targeted outlier areas also can be performed to determine the accuracy of data, the potential existence of under/over coding and whether educational opportunities exist for your facility. The data also can be used in other areas such as case management (i.e. determining that too many three-day stays are being discharged to SNFs, too many -one-day inpatient stays are occurring, etc.).

PEPPER data is a great tool to use in communicating the potential for an external audit of your organization due to outliers. Designating a point person to review these as each new quarter’s data is published and being aware of changes will help prepare your facility for future audits.

About the Author

Anissa Fabrizio, RHIA, CCS is the Administrative Director of Health Information Management and Patient Access for St. Anthony Central Hospital in Denver, Colorado.  Sponsored by Catholic Health Initiatives, St. Anthony Hospitals is part of Centura Health, Colorado’s largest family of hospitals and health care services and one of the state’s largest private employers, operating 12 hospitals, seven senior living communities and home care and hospice services.  Anissa has had various roles within HIM for the past 18 years, and currently serves as the Treasurer for the Colorado Health Information Management Association.

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