Strategies for Analyzing and Utilizing PEPPER in LTPAC Settings

Written by The Clinical Consulting Team | Jul 24, 2017 1:02:00 PM

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 st

atistics for one provider in areas (target areas) that may be at risk for improper Medicare payments. These target areas were selected by CMS because a national analysis of payment errors identified that they were high in either dollars in error or proportion of payment in error.

PEPPER 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:

Compare data statistics over time to identify changes in billing practices
Pinpoint areas in need of auditing and monitoring
Identify potential DRG under- or over-coding problems
Identify target areas where length of stay is increasing

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?

Access tables and graphs displaying billing activity over time in comparison with other hospitals and/or facilities
Review hospital- or facility-specific data and comparative target area statistics for the state, jurisdiction and country
Track and trend administrative data statistics to identify changes in billing practices and Medicare reimbursement for CMS target areas

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 (3^rd 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 (3^rd 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 3^rd 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 3^rd 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 3^rd 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 3^rd 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 3^rd 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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