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PEPPER Outlier Reports: Are you part of the 49%?

Posted by Margaret Scavotto, JD, CHC on 7/7/14 3:25 PM

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The latest Program for Evaluating Payment Patterns Electronic Reports (PEPPER) reports for SNFs, from 4th Quarter 2013, have been available since May 5. As of June 30, only 49% of SNFs have accessed their PEPPER reports. Are you one of the 49%?

To learn how to download your PEPPER, click here.  

It pays to be in the 49%

Your PEPPER report is a powerful compliance tool: it can help you compare your facility to other SNFs, and determine whether you have been identified as an outlier at risk for improper payments. PEPPER considers a SNF 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.  

Learn more

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


Topics: PEPPER, Auditing and Monitoring, Billing and Claims Submission

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