Breaking Compliance News Blog

2016 PEPPER Reports are here! Are you an outlier?

Posted by Margaret Scavotto, JD, CHC on 4/13/16 11:50 AM

Find me on:

PEPPER (Program for Evaluating Payment Patterns Electronic Report) reports for Q4FY15 have been released for SNF, LT, IRF, CAH and hospice providers, a few days ahead of schedule! You can access your PEPPER online. Home health providers can expect their PEPPERs to arrive in July.

This latest PEPPER uses statistics through September 2015, and will be available for download for approximately two years.

To download your PEPPER, the Compliance Officer, CEO, President or Administrator needs to:

  1. Visit the PEPPER Resources Portal
  2. Enter your information. You will need a Patient Control Number (form locator 03a on the UB04 claim form) *or* a Medical Record Number (form locator 03b on the UB04 claim form) for a claim of a traditional fee-for-service (FFS) Medicare patient/beneficiary who was receiving services at this provider with a “From” or “Through” date between September 1 - 30, 2015).
  3. Download your PEPPER.

If you need help, review the Secure PEPPER Access Guide.

Why PEPPER matters

Your PEPPER report can help you compare your facility to other providers, and determine whether you have been identified as an outlier at risk for improper payments. PEPPER considers a provider to be an outlier if its Target Areas are at or above the 80th percentile, or at or below the 20th percentile, depending on the area. If your PEPPER shows you are an outlier, an internal audit should be conducted to identify any improper payments or non-compliant practices. CMS is quick to point out that variances from the national data do not necessarily mean billing irregularities have occurred. However, it would be wise to know whether there is a reason why the government has identified you as an outlier.

In other words, the government is mining your data and evaluating your claims—and so should you. By incorporating PEPPER data into your compliance auditing strategy, you can identify potential areas of non-compliance that could make you a government target. And of course, a "good" PEPPER should not give you false confidence about your claims - it is a good practice to conduct documentation reviews to ensure claims are appropriate, even if you aren't an outlier.


Are you an outlier? Download  MPA's Guide to  PEPPER Reports  to find out

Topics: PEPPER

    Privacy Policy           Terms of Use