PEPPER Now Available: Have Concerns About Triggering in the Newly Released PDPM Areas?

The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available. This newly updated version reflects recent changes made to more accurately highlight PDPM areas of concern.

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. SNFs can use the data to support internal auditing and monitoring activities as part of their compliance program. The PEPPER Team does not provide PEPPERs to other contractors, although it does provide a Microsoft Access database to MACs and Recovery Auditors so areas of concern should be addressed.

The above PEPPER target areas were identified by CMS as being potentially at risk for improper Medicare payments. A high target area percent does not necessarily indicate the presence of improper payment or that the provider is doing anything wrong; however, under these circumstances, providers may wish to review their medical record documentation to ensure that the services their beneficiaries receive are appropriate and necessary, as well as to ensure that the documentation in the medical record supports the level of care and services for which they have received Medicare reimbursement.

The SNF PEPPER is available to the SNF’s Chief Executive Officer, Administrator, President, Quality Assurance and Performance Improvement Officer, or Compliance Officer through a secure portal on the website.

If you are concerned about outliers on your SNF PEPPER, ensure:

  • therapy/nursing staff have the skills necessary to provide          and document medically necessary treatments.
  • a triple check system is in place that monitors therapy, MDS and billing for accuracy

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