Pepper Reports are Available for SNF

Lisa Volk and Nancy Leveille

TMF Health Quality Institute which is contracted with the Centers for Medicare & Medicaid Services to develop, produce and disseminate provider-specific comparative data reports referred to as the Program for Evaluating Payment Patterns Electronic Report, or PEPPER. PEPPER summarizes one provider’s Medicare claims data statistics for areas that have been identified as at higher risk for improper Medicare payments. Providers can use the PEPPER to identify where they may be at higher risk for improper payments so they can consider their statistics and whether they should take any actions, such as reviewing a sample of records to ensure care provided was necessary and that documentation supports the diagnosis and procedure codes that were billed.

PEPPER has been available to skilled nursing facilities since 2013. We would like to encourage providers to access this free comparative billing report and utilize it as a tool to support their auditing and monitoring efforts.

Please note that the PEPPER team has developed maps that display the PEPPER retrieval rate for PEPPERs accessed via the PEPPER Resources Portal for each state/territory.  States on the interactive map are color-coded according to their retrieval rate.  Users can click on a state to obtain details such as the number of PEPPERs available in the state via the portal, the number of PEPPERs accessed via the portal, the retrieval rate and a link to the data file for all states/territories in the nation.

Map of SNF PEPPER Retrievals by State

If you have questions you can contact:
Cindy Hunter, M.Ed., CCM, HACP, CPHQ
Health Services Consultant II
TMF Health Quality Institute
3107 Oak Creek Drive, Suite 200
Austin, TX   78727-3107
(512) 334-1732
cindy.hunter@area-b.hcqis.org


NYSHFA CONTACTS:

Nancy Leveille, RN, MS
Executive Director
518-462-4800 x20

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15