Developments with MOON, PEPPER, and Payment Reductions for Out-of-Network Care

The PEPPER for the third quarter of 2025 is now available for download to your authorized officials. (I am hearing hospitals are struggling to figure out who that authorized official is, since the PEPPER previously was sent out via email to quality department staff.)

The good news is that we will be getting them with data that is more current than we used to see. The bad news, though, is that it appears there will be no significant changes to the report, except a new contractor producing the report. There are two tiny changes to a couple Diagnosis-Related Groups (DRGs) for the “Surgical CC/MCC (complication and comorbidity/major complication and comorbidity)” measure, and an Excel formatting change, but that is it. READ MORE 

AI, Interoperability, and the New Reality of Documentation Integrity in 2026

Healthcare has been transitioning toward a more digital, interconnected ecosystem for many years, but the pace and magnitude of current changes represent a fundamental shift.

The combined influence of artificial intelligence (AI)-enabled documentation tools and the federal push toward real-time interoperability is rapidly transforming how information is created, exchanged, and evaluated. As a result, documentation of quality issues now surfaces faster and carries greater operational, financial, and clinical consequences.

For professionals working across clinical documentation integrity (CDI), utilization review (UR), case management, and clinical operations, 2026 should be viewed as a pivotal inflection point – one in which documentation integrity must be understood not as a discrete coding or compliance function, but as a foundational element of patient care, payer interaction, and organizational resilience. READ MORE