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Leveraging PEPPER Reports in SNFs

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With the government’s watchful eye on reducing Medicare fraud, payments to skilled nursing facilities were identified as highly vulnerable to abuse. A PEPPER report contains your facility’s Medicare claim statistics for any “at risk” areas for potential Medicare fraud. PEPPER is now available to skilled nursing facilities, as reports were sent out at the end of August. The reports contain data statistics on the Medicare claims that your facility has made in the past three fiscal years and benchmarks you against the rest of your state, the entire country and the Medicare Administrative Contractor/Fiscal Intermediary jurisdiction.

These reports focus on specific “Target Areas” that include episodes of care that may lead to a higher risk for fraud, including:

  • Therapy RUGs with High ADLs
  • Non-therapy RUGS with High ADLS
  • Change of Therapy Assessment
  • Ultrahigh Therapy RUGS
  • Therapy RUGS
  • 90+ Day Episodes of Care

These reports are being distributed to help highlight areas that may be of concern to SNFs. The comparison data is useful for prioritizing areas that require additional monitoring and auditing. Within its User Guide, detailed resources are provided to help you analyze the reports and evaluate what your standings mean.

To learn more about PEPPER, visit the PEPPER website.

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