The link below provides national-level statistics for areas identified as at-risk for improper payments in short-term acute care hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in the nation. For more information on the areas identified as at risk for improper payments, please see the Short-term PEPPER User’s Guide (PDF, 36th Edition Q2FY23).

A listing of the top 20 medical DRGs by volume of Medicare discharges for same- and one-day stays for all short-term acute care PPS hospitals in the nation. The data are aggregated at the national level. A same-day stay occurs when a patient is admitted as an inpatient and discharged on the same day; a one-day stay occurs when a patient is admitted as an inpatient on one day and discharged on the following day. When the patient dies, leaves against medical advice or is transferred to another short-term acute care PPS hospital (patient status codes 20, 07 02 or 82), or when the claim has occurrence span code 72 (identifying outpatient time associated with an inpatient admission) with “through” date on or day prior to inpatient admission, these claims are not included in the data. These data represent the most recent four quarters of Medicare discharges.

A listing of the top 20 surgical DRGs by volume of Medicare discharges for same- and one-day stays for all short-term acute care PPS hospitals in the nation. The data are aggregated at the national level. A same-day stay occurs when a patient is admitted as an inpatient and discharged on the same day; a one-day stay occurs when a patient is admitted as an inpatient on one day and discharged on the following day. When the patient dies, leaves against medical advice or is transferred to another short-term acute care PPS hospital (patient status codes 20, 07, 02 or 82), or when the claim has occurrence span code 72 (identifying outpatient time associated with an inpatient admission) with “through” date on or day prior to inpatient admission, these claims are not included in the data. These data represent the most recent four quarters of Medicare discharges.

The link below provides state-level statistics for areas identified as at-risk for improper payments in short-term acute care hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for each state/territory. Target area statistics are reported when there are at least three hospitals with 11 target area discharges in a state/territory. For more information on the areas identified as at risk for improper payments, please see the Short-term PEPPER User’s Guide (PDF, 36th Edition).

A listing of the top 20 medical DRGs by volume of Medicare discharges for same- and one-day stays for all short-term acute care PPS hospitals in each state/territory. A same-day stay occurs when a patient is admitted as an inpatient and discharged on the same day; a one-day stay occurs when a patient is admitted as an inpatient on one day and discharged on the following day. When the patient dies, leaves against medical advice or is transferred to another short-term acute care PPS hospital (patient status codes 20, 07 02 or 82), or when the claim has occurrence span code 72 (identifying outpatient time associated with an inpatient admission) with “through” date on or day prior to inpatient admission, these claims are not included in the data. DRGs are included in the report if there are at least 11 discharges for the DRG in the most recent four quarters of Medicare discharges in a state/territory.

A listing of the top 20 surgical DRGs by volume of Medicare discharges for same- and one-day stays for all short-term acute care PPS hospitals in each state/territory. A same-day stay occurs when a patient is admitted as an inpatient and discharged on the same day; a one-day stay occurs when a patient is admitted as an inpatient on one day and discharged on the following day. When the patient dies, leaves against medical advice or is transferred to another short-term acute care PPS hospital (patient status codes 20, 07, 02 or 82)), or when the claim has occurrence span code 72 (identifying outpatient time associated with an inpatient admission) with “through” date on or day prior to inpatient admission, these claims are not included in the data. DRGs are included in the report if there are at least 11 discharges for the DRG in the most recent four quarters of Medicare discharges in a state/territory.

A graph of the total number of high outliers (as identified from the National High Outlier Ranking Report in the PEPPER) for all hospitals in the Nation, for the Q2FY23 ST PEPPER release.

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for short-term acute care hospitals in four categories: location, ownership type, teaching status and surgical focus. The statistics were calculated for Medicare discharges occurring in the first quarter of fiscal year 2023 (October 1 – December 31, 2022). For details on how these charts were developed please see the ST Peer Group Methodology document (PDF, updated 3-25-2019). For a listing of all hospitals and their peer group classification please see the ST hospitals by peer group file (PDF, updated 06/01/2023). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.