PEPPER summarizes Medicare claims data statistics for billed claims in target areas that may be at risk for improper payments. Your facility data is compared to all SNFs in the nation, in your state, and in your jurisdiction to assess how your past billing practices compare to peers. CMS uses PEPPER as a means of program integrity monitoring and to help providers identify their potential risks of fraud, waste, and abuse. The current version of PEPPER which is now available reviews episodes of care that run through quarter 4 of FY2019 including statistics for 2017, 2018, and 2019. SNF PEPPER identifies high outliers (at or above the 80th percentile) as well as low outliers (at or above the 20th percentile) for each target area.
Target Area Updates
The following RUGs focused target areas will be phased out for FY2020 due to the conversion to PDPM: Therapy RUGS with High ADL, Nontherapy RUGs with High ADL, Change of Therapy Assessment, & Ultrahigh Therapy RUGS. These target areas are included in the current FY2019 report along with the target areas: 20 day episodes of care, 90+ day episodes of care, as well as a new target area: 3-5 day readmissions which reviews readmissions to the SNF following a 3-5 calendar day gap. This target area will not reflect claims until FY2020, but is meant to give providers information on readmission practices before and after PDPM implementation with the goal of assessing the level to which facilities “may attempt to circumvent interrupted stay rules” per the PEPPER contractor.
The SNF FY2020 PEPPER will be the first to include PDPM claims data and is expected to be released on or around April 2021.
Contact Proactive for compliance-focused SNF PEPPER analysis, claims audits in follow up to SNF PEPPER outliers, and Medicare documentation/MDS coding support services. Find information on training and accessing your report below:
| Skilled Nursing Facility PEPPER Available The Q4FY19 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2019 is now available for download through the PEPPER Resources Portal. To obtain your SNF PEPPER, the Chief Executive Officer, President, Administrator, Compliance Officer, or Quality Assurance/Performance Improvement Officer of your organization should:
The SNF PEPPER will be available to download for approximately two years. SNF swing bed units that are administered by short-term acute care hospitals will receive their PEPPER via the QualityNet secure portal by July 29, 2020, via an upload to the “AutoRoute_inbox” of QualityNet account administrators and those with user accounts with the PEPPER recipient roles. QualityNet administrators will receive download instructions in a separate email. A recorded webinar that reviews the Q4FY19 SNF PEPPER can be found on the SNF “Training and Resources” page. PEPPER’s New and Improved Format SNF PEPPER has a new and improved format. While all of the data and information that you are used to seeing in your PEPPER is still available, the new format includes greater accessibility, cleaner presentation, and improved readability. To help introduce you to the new format of PEPPER, we have prepared a recorded webinar demonstration of the new PEPPER, which is available on the PEPPER website. PEPPER files are now created in Excel 2016 as .xlsx files. Customers with an earlier version of Excel for whom upgrading to a newer version of Excel is not possible may find options to open the PEPPER file via an internet search. For example, you might search the following phrase to find free software that can open .xlsx files: “how to open xlsx files.” About PEPPER PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit the SNF “Training and Resources” page on the PEPPER website to access updated resources for using PEPPER, including recorded web-based training sessions, a sample SNF PEPPER, and the current SNF PEPPER User’s Guide. PEPPER is developed under contract with the Centers for Medicare & Medicaid Services (CMS) by RELI Group, along with its partners TMF® Health Quality Institute and CGS. Do you have questions or comments about PEPPER or need help obtaining your report? Visit our Help Desk to request assistance with PEPPER. Provide your feedback or suggestions regarding PEPPER through our feedback form. |
