The latest PEPPER (Program for Evaluating Payment Patterns Electronic Report) reports have been released for SNF, LT, IRF, IPF, CAH and hospice providers. You can access your PEPPER online. Home health providers and partial hospitalization programs can expect their PEPPERs to arrive in July 2019.
This latest PEPPER uses statistics for October 1, 2017 through September 30, 2018. To download your PEPPER, the Chief Executive Officer, President, Administrator, Compliance Officer, or Quality Assurance/Performance Improvement Officer needs to:
- Visit the PEPPER Resources Portal
- Enter your information. Note: A patient control number (UB04 form locator 03a) or medical record number (UB04 form locator 03b) from a claim for a traditional Medicare FFS beneficiary with a claim "from" or "through" date between July 1 - Sept. 30, 2018, will be required.
- Download your PEPPER!
If you need help, review the Secure PEPPER Access Guide.
Will you get your PEPPER? You should.
Last year, on average, less than half of providers viewed their PEPPER reports. For example:
- IL: 50.79%
- CA: 44.93%
- NY: 44.86%
(% of SNFs that accessed their PEPPER reports in the state between April 16, 2018 and March 20, 2019).
Providers who who don't download their PEPPERs are missing out on some valuable data.
Why PEPPER matters
Your PEPPER report can help you compare your organization 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 determine 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 – MPA recommends conducting documentation reviews to ensure claims are appropriate, even if you aren't an outlier.
PEPPER comes once a year, but our attention to it should be ongoing. Don't wait for the report to be released in April. Work with your billing department to see what reports you can run internally to track the Target Areas as part of your compliance efforts. This way, there will be no surprises in April 2020.