The RELI Group, along with its partners TMF Health Quality Institute and CGS, is contracted with the Centers for Medicare & Medicaid Services to develop, produce and disseminate provider-specific comparative data reports, referred to as the Program for Evaluating Payment Patterns Electronic Report, or PEPPER. PEPPER summarizes one provider’s Medicare claims data statistics and provides comparative data with the state, jurisdiction and nation. Providers can review the PEPPER to evaluate their statistics and determine whether they should take any actions, such as reviewing records to ensure the care provided was necessary, and that documentation supports the diagnosis codes and services billed.
We would like to encourage providers to access this free comparative billing report and utilize it as a tool to support their auditing and monitoring efforts. With that in mind, would you consider sharing the one page summary (attached), electronically via e-mail or newsletter, with your membership?
If you have any questions, please feel free to contact me.
Cindy Hunter, M.Ed., CCM, HACP, CPHQ
Healthcare Quality Improvement Specialist III
TMF Health Quality Institute
3107 Oak Creek Drive, Suite 200
Austin, TX 78727-3107
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a Microsoft Excel workbook that summarizes provider-specific Medicare claims data statistics for areas that have been identified as prone to improper Medicare payments due to billing, coding and/or admission necessity issues. These areas are identified by the Centers for Medicare & Medicaid Services (CMS).
PEPPER facilitates the prioritization of areas for which a provider may want to focus internal auditing and monitoring efforts. As part of an effective compliance program, providers are encouraged to conduct regular audits to ensure that services provided to Medicare beneficiaries are appropriate and in accordance with Medicare payment policy, that documentation supports the services billed, and that claims are correctly coded and submitted.
PEPPER can be used to review three years of data statistics for each of the PEPPER target areas, comparing performance to that of other providers in the nation, Medicare Administrative Contractor (MAC) jurisdiction, and state. PEPPER can also be used to compare data statistics over time to identify changes in billing practices, pinpoint areas that may benefit from internal auditing and monitoring, identify potential coding errors, and identify areas where lengths of stay are increasing or decreasing. PEPPER is an educational tool that can help providers achieve CMS’ goal of protecting the Medicare Trust Fund.
PEPPER is available for the following provider types:
- Short-term acute care hospitals (developed in 2002),
- Long-term acute care hospitals (developed in 2005),
- Critical access hospitals, inpatient psychiatric facilities and inpatient rehabilitation facilities (developed in 2011),
- Hospices and partial hospitalization programs (developed in 2012),
- Skilled nursing facilities (developed in 2013), and
- Home health agencies (developed in 2015).
Visit https://pepper.cbrpepper.org/ for more information on PEPPER, including sample reports, user’s guides, recorded training sessions and national-level comparative data. View the PEPPER distribution schedule and information on how to get your organization’s PEPPER.
If you have questions, visit our Help Desk to request assistance with PEPPER.