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It is that time of year for you to review your PEPPER!
Every year at this time we look forward to the release of The Program for Evaluating Payment Patterns Electronic Report (PEPPER). PEPPER is a Microsoft Excel file summarizing provider-specific Medicare data statistics for target areas often associated with Medicare improper payments due to billing, diagnosis-related group (DRG) coding and/or admission necessity issues. Target areas are determined by the Centers for Medicare & Medicaid Services (CMS).
PEPPER summarizes the Medicare claims data stPEPPER can be used to review three years of data statistics for each of the CMS target areas, comparing performance to that of other hospitals or facilities in the nation, same specific Medicare Administrative Contractor (MAC) jurisdiction and/or state. PEPPER can also be used to:
Broadly speaking, PEPPER can help hospitals and long-term post-acute care (LTPAC) facilities achieve CMS’ goal of reducing and preventing improper payments.
What Should Your Organization Use PEPPER For?
How Can You Find Your PEPPER?
|
Provider Type |
Distribution Schedule |
Distribution Method |
|
Skilled Nursing Facilities |
Annually, on or about April 17, 2017 |
SNFs/swingbeds that are part of a short-term acute-care hospital (3rd digit in the PTAN/CMS certification number/provider number = “U”): Electronically via QualityNet Portal
Freestanding SNFs and SNFs that are part of another type of hospital (3rd digit in the PTAN/CMS certification number/provider number = 5 or 6): Available electronically to an SNF’s CEO, president, administrator or compliance officer via the PEPPER Resources Portal. You will need to enter your six-digit CMS Certification Number (also referred to as Provider Number or PTAN). The 3rd digit of this number will be a 5 or a 6.
|
|
Short-Term Acute-Care Hospitals |
Quarterly, on or about December 5, 2016, March 6, 2017, June 5, 2017, August 31, 2017 |
Electronically via QualityNet Portal |
|
Critical Access Hospitals |
Annually, on or about April 14, 2017 |
Electronically via QualityNet Portal |
|
Home Health Agencies |
Annually, on or about July 17, 2017 |
Available electronically to the agency’s CEO, president, administrator or compliance officer via the PEPPER Resources Portal. You will need to enter your six-digit CMS Certification Number (also referred to as Provider Number or PTAN) (see special note). The 3rd digit of this number will be a 3, 7, 8 or 9. |
|
Hospices |
Annually, on or about April 17, 2017 |
Available electronically to the hospice’s CEO, president, administrator or compliance officer via the PEPPER Resources Portal. You will need to enter your six-digit CMS Certification Number (also referred to as Provider Number or PTAN). The 3rd digit of this number will be a 1. |
|
Inpatient Psychiatric Facilities |
Annually, on or about April 14, 2017 |
Freestanding IPFs and IPF Distinct Part Units of short-term acute-care and critical access hospitals: Electronically via QualityNet Portal |
|
Inpatient Rehabilitation Facilities |
Annually, on or about April 17, 2017 |
Freestanding IRFs: Available electronically to the IRF’s CEO, president, administrator or compliance officer via the PEPPER Resources Portal. You will need to enter your six-digit CMS Certification Number (also referred to as Provider Number or PTAN). The 3rd digit of this number will be a 3.
IRF Distinct Part Units of short-term acute-care and critical access hospitals: Electronically via QualityNet Portal |
|
Long-Term Acute-Care Hospitals |
Annually, on or about April 17, 2017 |
Available electronically to the hospital’s CEO, president, administrator or compliance officer via the PEPPER Resources Portal. You will need to enter your six-digit CMS Certification Number (also referred to as Provider Number or PTAN). The 3rd digit of this number will be a 2. |
For more information visit: https://www.pepperresources.org/.
Contact Richter Healthcare Consultants:
Do you have questions about PEPPER or other Medicare administration challenges? Call Richter’s financial consultants at 866-806-0799 to schedule a free consultation.
Jennifer Leatherbarrow, RN BSN, RAC-CT, QCP, CIC is the Senior Clinical Consultant with Richter Healthcare Consultants.
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