The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a Microsoft Excel file summarizing provider-specific Medicare data statistics for target areas often associated with improper Medicare payments due to billing, DRG coding and/or admission necessity issues. Target areas are determined by the Centers for Medicare & Medicaid Services (CMS).
PEPPER facilitates the prioritization of areas on which a provider may want to focus auditing and monitoring efforts. Providers are encouraged to conduct regular audits to ensure that medical necessity for admission and treatment is documented and that bills submitted for Medicare services are correct.
PEPPER can be used to review three years of data statistics for each of the CMS 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 in need of auditing and monitoring, identify potential DRG under- or over-coding problems and identify target areas where lengths of stay are increasing. PEPPER can help providers achieve CMS’ goal of reducing the likelihood of improper Medicare payments.
TMF, at CMS’ direction, has developed various types of PEPPER including:
• 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 PEPPERresources.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.
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