What is the Program for Evaluating Payment Patterns Electronic Report (PEPPER)?
- PEPPER is developed and distributed by TMF Health Quality Institute, under contract with the Centers for Medicare & Medicaid Services (CMS).
- National Skilled Nursing Facility (SNF) claim data was analyzed to identify areas within the SNF Prospective Payment System (PPS) that could be at risk for improper Medicare payment. PEPPER is a data report that contains a SNF’s Medicare claims data (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC) or Fiscal Intermediary (FI)).
- PEPPER contains provider-specific Medicare data statistics for discharges or services vulnerable to improper payments. Target areas were identified based on a review of literature regarding SNF payment vulnerabilities, review of the SNF PPS, analysis of claims data and coordination with CMS subject matter experts. PEPPER can support a facility’s compliance efforts by identifying potential overpayments or underpayments.
- All SNFs that have sufficient data to generate a report will receive a PEPPER. The report shows how a SNF’s data compares to aggregate jurisdiction, state and national statistics. If the SNF’s target area percent is at/above the national 80th percentile or at/below the national 20th percentile, the SNF is identified as at risk for improper Medicare payments. PEPPER is only available to the individual SNF.
SNFs that are part of a short-term acute care hospital will receive their PEPPER electronically via QualityNet, sent to the hospital QualityNet Administrator. All other SNFs will receive their PEPPER in hard-copy format via United States Postal Service first class mail. The envelope will appear as the image below, addressed to the CEO/Administrator. If still unable to locate, submit a request for assistance via the PEPPERresources.org Help Desk.
PEPPERresources.org is the official site for information, training and support.
Training & resources for Skilled Nursing Homes are now available on the website at www.pepperresources.org/TrainingResources/SkilledNursingFacilities.aspx.
If you have questions about the PEPPER reports, you may submit questions on this website through the Help/Contact Us tab.
Please do not contact your state QIO or state survey agency for assistance with PEPPER.