PEPPER Reminder

In July, Center for Medicare and Medicaid Services (CMS) contractor TMF Health Quality Institute [HQI] informed the American Health Care Association that HQI was sending out, via regular mail, the attached postcard to all 15,000+ SNFs.  

The postcard indicated to skilled nursing facility (SNF) providers that it will soon receive a report called the Program for Evaluating Payment Patterns Electronic Report (PEPPER). This report provides Medicare claims data in specific targeted areas comparing the SNF to other SNFs throughout the US.  The Report will be mailed to SNFs via regular mail on August 30th.  AHCA did request that SNFs be allowed to receive all of their facility information via electronic format, but so far the CMS has determined this is not possible.

The PEPPER program was initiated in 2003, but since 2003 has focused on other types of providers over the years.  It is now adding SNFs. PEPPER gives provider-specific Medicare data statistics for services vulnerable to improper payments, according to the federal government, and allows providers to see how their facility compares to all other SNFs across the state, nation or MAC jurisdiction.  For SNFs, the targeted areas were determined by recent OIG reports in 2010 and 2012 and conversations with CMS staff, and include:

  • Therapy RUGs with High ADLs
  • Nontherapy RUGs with High ADLs
  • Change of Therapy Assessment

PEPPER data is shared with both the MACs and the Medicare Recovery Auditors (RAs), but not the Zone Program Integrity Contractors (ZPICs).  HQI did acknowledge, however, that CMS contractors have much more sophisticated databases and systems for looking at SNF Medicare claims data.

For more information on SNF PEPPER, click here. A new user guide has recently been added to the SNF section.