PEPPER, Anyone?

PEPPER reports have been around in the acute world since 2003, and now they are trickling over to the other worlds of healthcare. “Program for evaluating payment patterns electronic report,” or PEPPER programs, have been recently introduced to skilled nursing facilities.

This report contains data on your SNF’s Medicare claims statistics. Though PEPPER does not identify issues with payments, it does give clues of what areas may be target for an audit. Thus, you get to do your internal review before Big Brother.

As your facility receives this report, who should be looking at it? In my opinion, it should be your director of rehab, MDS coordinator, billing personnel, director of nursing and QA manager.

This report includes areas such as therapy services with high ADL scores, non-therapy services with high ADL scores, changes in therapy assessments, ultrahigh therapy rug scores, therapy rugs and 90-plus day episode of care. All of these have been red flags and hot topics for reviews by RACs, MACs and OIG in the past, so no surprise that TMF (a private organization working these statistics) has used these criteria to review.

Once you see a percentile for your facility and how it relates to the state and national averages, you may want to audit areas that fall above 80% and below 20% in order to minimize the risk for improper Medicare billing. Use this tool to be ahead of the game.

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