Healthcare Acronyms

Program for Evaluating Payment Patterns Electronic Report

The report, created by Medicare's HPMP, provides the results of focused audits on potential problem areas and provides to hospitals. The 13 target areas with frequent payment errors (under or overcoding) include one-day inpatient hospital stays (listing the hospital's top 10 one-day stay admissions), seven day readmits, three day nursing home qualifying stays, coding of complications and co-morbidities (used to optimize to a higher paying DRG) and a focus on nine problematic primary diagnoses/DRGs (heart failure and shock, chest pain one day stays, gastroenteritis and other digestive disorders one day stays, nutritional and metabolic disorders one-day stays, intracranial hemorrhage and stroke with infarct, simple pneumonia, complex pneumonia, back problems and septicemia). The source of the data is Medicare's own inpatient hospital discharge data. The PEPPER report is compiled quarterly and provided to hospitals by their Medicare Quality Improvement Organization (QIO). Hospitals use this data to focus their monitoring and auditing efforts and track improvement over time and to compare their performance with other hospitals in their state and nationwide.