June 13, 2016

Time to Download Your SNF or Hospice PEPPER

By Janet Potter, Senior Manager, Advisory Services

Time to Download Your SNF or Hospice PEPPER

It is time once again for skilled nursing facilities (SNFs) and hospice agencies to access their Program for Evaluating Payment Patterns Electronic Report (PEPPER). This annual report is a great tool to be used in the corporate compliance program to help organizations identify risk areas. According to TMF Health Quality Institute, the contractor which produces the reports, 41% of SNFs and 45% of hospices did not download their PEPPERs last year. We strongly urge all providers to obtain their PEPPER and utilize it in their self-audit and corporate compliance processes. The updated PEPPER can be downloaded now by the CEO, President, Administrator, or Compliance Officer. In order to access the PEPPER, either a patient control number or a medical record number from a fee-for-service Medicare beneficiary who received services between September 1 and September 30, 2015 is needed. The PEPPER can be obtained at https://www.pepperresources.org/, by clicking on “PEPPER Distribution – Get Your PEPPER” under the appropriate provider type name.

The current PEPPER (Q4FY15) will summarize Medicare fee-for-service claims data statistics from October 1, 2012 through September 30, 2015. The PEPPER provides a comparison of the target areas for each provider with the nation, their Medicare Administrative Contractor (MAC) Jurisdiction, and their state. Target areas above the 80th percentile or below the 20th percentile are considered outliers and should be reviewed closely as part of the self-audit. Note that hospice target areas identify only outliers above the 80th percentile, as low outliers are not an appropriate measure for those specific targets.

Hospice agencies will see four new target areas with this year’s report:

  • Live Discharges – Revocations.
  • Live Discharges with length of stay between 61-179 days.
  • Claims with a Single Diagnosis coded.
  • Claims with no general inpatient care (GIP) or continuous home care (CHC).

By reviewing your PEPPER and identifying potential areas of weakness in your claims and documentation processes, you can avoid costly payment denials should your claims be subject to medical review by Medicare.

Your Marcum advisor can help you review your PEPPER and determine areas for closer examination and audit. We can provide documentation and claims coding reviews to identify potentially miscoded items or poor supporting documentation. 

Please call (847) 282-6300 to speak to a member of our Healthcare team.