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Using PEPPER to Identify Improper Payment Risks

 
In recent years, the government has identified billions of dollars that were improperly paid through Medicare and Medicaid programs. As a result, hospitals now face a new era of health care audit accountability and run the risk of falling into the gray zone of incorrect medical necessity determinations, improper payments and denials. Learn how to develop a proactive approach of assessing potential compliance vulnerabilities through the use of data analysis and benchmarking tools. Hospitals can use publicly available MedPAR data and tools such as the Program for Evaluating Payment Patterns Electronic Report (PEPPER) to identify their areas of risk. This internal risk assessment can also assist each hospital’s utilization review committee to identify areas for potential compliance program enhancement.

Faculty

Ralph Wuebker, MD, MBA

Ralph Wuebker, MD, MBA

Executive Health Resources

Agenda

Faculty

Ralph Wuebker, MD, MBA

Ralph Wuebker, MD, MBA

Executive Health Resources

  • Serves as chief medical officer of Executive Health Resources (EHR)
  • Provides clinical leadership within EHR and works closely with hospital leaders to ensure strong utilization review and compliance programs
  • Additionally, oversees EHR’s Audit, Compliance and Education (ACE) physician team, which is focused on providing on-site education for physicians, case managers, and hospital administrative personnel and on helping hospitals identify potential compliance vulnerabilities through ongoing internal audit
  • Serves as an industry thought leader and editorial advisor to the media
  • Has been published in many prominent industry trade publications, including Report on Medicare Compliance, RACmonitor, and Compliance Today
  • An active participant and respected source for industry discussion boards, blogs and other social media
  • Highly respected and distinguished speaker at industry conferences and EHR-hosted educational events
  • Throughout his career, he served as a hospitalist and instructor of medicine at Washington University School of Medicine and St. Louis Children’s Hospital
  • Continues his clinical practice three to four days a month with his former private practice group
  • M.B.A. degree, Washington University in St. Louis, Missouri; medical degree and bachelor’s degree in biology, University of Missouri-Kansas City School of Medicine

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