In a national effort to reduce billing errors from skilled nursing facilities, the Centers for Medicare and Medicaid Services has drawn up individual claims reports for facilities and implemented a program known as “PEPPER” (Program for Evaluating Payment Patterns Electronic Report). Each PEPPER report examines episodes of care from October 1, 2009 to September 30, 2012 and looks for areas that are at risk for improper Medicare reimbursement. PEPPER reports were mailed to SNFs beginning on September 30, 2013. The reports are intended to help SNFs remain in compliance by correctly billing for services administered.
Note that PEPPER cannot actually identify improper payments. By looking for outliers, the PEPPER report only analyzes your SNF’s claims data to highlight areas of potential payment abuse. For example, the report pays special attention to target areas such as therapy RUGs with high ADLs, episodes of care lasting more than 90 days and ultra high therapy RUGs. For more background about the PEPPER reports, we recommend reading Shelly Mesure’s column on McKnight’s Long-Term Care News: What’s On Your PEPPER Report?
In addition, RehabCare recently held a webinar to help skilled nursing facilities understand how to respond to their PEPPER letters.
For official CMS information and resources for PEPPER, visit: http://www.pepperresources.org/.