Have You Accessed Your PEPPER Report?

Mary Madison, RN, RAC-CT, CDP 
Clinical Consultant – Briggs Healthcare

There’s a lot of data entry and data reporting these days – all are important.  Don’t forget to look at your facility’s PEPPER report!

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit PEPPER.cbrpepper.org to access resources for using PEPPER, including user’s guides, recorded web-based training sessions, and a sample PEPPER. PEPPER is developed under contract with the Centers for Medicare & Medicaid Services (CMS) by RELI Group, along with its partners TMF® Health Quality Institute and CGS.

Have you accessed your PEPPER? If not, you can boost your state’s rates:

  1. Visit the “Distribution Schedule – Get Your PEPPER page” at PEPPER.cbrpepper.org.
  2. Review the instructions and obtain the information required to authenticate access.
  3. Access the PEPPER Resources Portal.
  4. Complete all the fields.
  5. Download your PEPPER.

The PEPPER Team has updated the maps that display the PEPPER retrieval rates for PEPPERs accessed via the PEPPER Resources Portal for each state/territory. Percentages reflect the PEPPER release that was completed on March 7, 2022, for short-term acute care hospitals (STACHs), that was completed on April 5, 2021, for skilled nursing facilities (SNFs), critical access hospitals (CAHs), hospices, inpatient psychiatric facilities (IPFs), inpatient rehabilitation facilities (IRFs), and long-term acute care hospitals (LTACHs), and that was completed on July 9, 2021, for home health agencies (HHAs) and partial hospitalization programs (PHPs).

Please click on a link below to view the maps. States on the interactive maps are color-coded according to their retrieval rates. Click on a state to obtain details, such as the number of PEPPERs available in the state via the portal, the number of PEPPERs accessed via the portal, and the retrieval rates. The maps are updated with the latest retrieval information on a daily basis.

Note: Recently, the national-level retrieval rates were added to the retrieval map for each state. 

Do you have questions or comments about PEPPER or need help obtaining your report? Provide your feedback or suggestions regarding PEPPER through our feedback form, and visit our Help Desk to request assistance with PEPPER. 

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 Medicare improper 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 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 nation, specific 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 length of stay is increasing. PEPPER can help hospitals and facilities achieve CMS’ goal of reducing and preventing improper payments.

Check out Who Benefits from PEPPER? here.  There are tips for CEOs/CFOs/Administrators, Compliance Officers, UR/QI Staff and HIM Staff.