September 14, 2013
Rick Gawenda
Skilled nursing facilities initiating compliance programs are encouraged to review Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports recently sent to each facility by the Centers for Medicare & Medicaid Services (CMS). These free provider-specific comparative data reports help identify billing practices which may be at risk for administrative review.
CMS began mailing PEPPER to skilled nursing facilities in August 2013. PEPPER, or program for evaluating payment patterns electronic report, provides facility-specific data statistics for services provided to Medicare beneficiaries. PEPPERs compare a SNF’s claims data statistics with aggregate statistics from similar facilities in the state, Medicare administrative jurisdiction, and around the United States.
Facilities with billing patterns at or above the national 80th percentile are identified as “outliers.” CMS encourages facilities that spot outliers on their PEPPER to review Medicare payment policy to ensure provided services are medically necessary and that medical record documentation supports services billed.
SNFs that are a part of a short-term acute care hospital may access their PEPPER electronically through the hospital QualityNet system. CMS mailed hard copy PEPPER reports for free-standing SNFs and SNFs administered through long-term acute care hospitals and inpatient rehabilitation facilities on August 30, 2013.
For more information, visit the PEPPER website.

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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