Administrative Memos

200603

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jun 13, 2006
SUBJECT: IPRO LONG TERM ACUTE CARE HOSPITAL PEPPER DATA DISTRIBUTION
IPRO CONTACTS:

Kathy Terry, Ph.D., Sr. Director, Data Analysis & Evaluation, Medicare/Federal Health Care Assessment at 516-209-5364

Recently the Centers for Medicare & Medicaid Services (CMS) released Hospital Payment Monitoring Program (HPMP) target areas and data contained within these target areas for long-term acute care (LTAC) hospitals. These target areas focus on discharges at risk for payment errors due to incorrect coding-DRG assignment and/or potential unnecessary admissions.

IPRO is distributing a CMS administrative data tool to each LTAC hospital to assist in identifying potential payment errors for each of the target areas. This tool, called PEPPER (for Program for Evaluating Payment Patterns Electronic Report), provides hospital-specific Medicare discharge data for fiscal years (FYs) 2003, 2004, 2005 and 2006 to date. These data provide detail on your hospital's standing in relation to other NYS LTAC hospitals, dollars received as payment for each year for target areas, length of stay data, and more. These data have been provided on the enclosed CD-Rom and, are presented in tabular and graphic formats which may be manipulated through the Excel tool in which they are distributed. A PEPPER Users Guide is also provided on the CD-Rom.

The Office of the Inspector General (OIG) published "The Office of Inspector General's Compliance Program Guidance for Hospitals" which encourages hospitals to develop and implement a compliance program. One aspect of a compliance program involves ensuring that charges for Medicare services are correctly documented and billed. To this end, hospitals should be conducting regular audits to ensure that charts document the need for the setting of care, including the treatment, and that the bills for services are correct. These PEPPER data disseminated by IPRO may be used to guide your auditing efforts.

A conference call and web training by IPRO to assist in your interpretation and use of the LTAC PEPPER data will be offered on June 28, 2006 at 12:00 pm. Hospitals must register to participate in this Learning Session with registration available at https://ifmcevents.webex.com. It is strongly suggested that at least one (1) hospital representative participate in the live session so that your hospital's specific concerns and/or questions may be addressed. Detailed registration instructions for the session are found in Attachment A. Note that hospital participants will need access to both the Internet and a telephone line for participation in the training. We encourage you to have the staff within your facility share the computer/phone line used for the training event, when possible.

Should you have any questions or comments about this memorandum and/or the training please contact Kathy Terry, Ph.D., Sr. Director, Data Analysis & Evaluation, Medicare/Federal Health Care Assessment at 516-209-5364.