Next PEPPER Release for SNFs, Hospices, LTCHs, Free-Standing IPFs, IRFs, and PHPs to be Available Electronically
TMF Health Quality Institute is developing a secure web portal through which certain providers can access their Program for Evaluating Payment Patterns Electronic Report (PEPPER). To date, PEPPERs have been available electronically to some providers through QualityNet and in hard-copy format via mail to providers that did not have access to QualityNet.
PEPPER facilitates the prioritization of areas on which a hospital or facility may want to focus auditing and monitoring efforts. Hospitals and facilities 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 hospitals or facilities in the state, specific Medicare Administrative Contractor (MAC) jurisdiction and the nation. Note that currently, the FIs are in the process of transitioning to the MACs. Several FIs process claims for hospitals in many states. As the FIs transition to the MACs, only hospitals in a state that is within a current MAC/FI jurisdiction are included in the state comparison group.
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 length of stay is increasing. PEPPER can help hospitals and facilities achieve CMS’ goal of reducing and preventing improper payments.
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TMF is contracted with CMS to produce and distribute the PEPPER for short-term acute care hospitals, long-term acute care hospitals, critical access hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, hospices, partial hospitalization programs and skilled nursing facilities.
TMF’s secure portal will allow access to PEPPER for providers who do not have access to QualityNet, which includes the following:
• Long-term acute care hospitals
• Free-standing inpatient rehabilitation facilities
• Partial hospitalization programs not associated with a short-term acute care hospital
• Skilled nursing facilities not associated with a short-term acute care hospital
TMF anticipates the PEPPERs for these providers will be made available for download in April/May 2014; they will remain accessible for approximately one year. To receive notification when the PEPPER is available and guidance on accessing the PEPPER, join the email list at PEPPERresources.org (see the gray box on the upper right section of the Home page).
For more information, visit PEPPERresources.org.