National SNF claims data is analyzed to identify areas within the SNF Prospective Payment System (PPS), for potential areas at risk for improper Medicare payment.

These areas are referred to as “target areas.” PEPPER is a data report that contains a single SNF’s Medicare claims data statistics (obtained from the UB-04 claims) submitted to the Medicare Administrative Contractor (MAC) or Fiscal Intermediary (FI) for these target areas. All SNFs that have sufficient data to generate a report receive a PEPPER, which contains statistics for these target areas.

The report shows how a SNF’s data compares to aggregate jurisdiction, state and national statistics. Statistics in PEPPER are presented in tabular form as well as in graphs that depict the SNF’s target area percentages over time. All of the data tables, graphs and reports in PEPPER were designed to assist the SNF in identifying potentially improper payments. PEPPER reports are part of the SNF compliance program and annual work plan.

How can Harmony Healthcare International, Inc. (HHI) help?

  • Provide summary analysis of the National Data for the most recent Fiscal Year and a three year PEPPER trending summary
  • Medical record reviews to explore each of the following five elements:  Therapy and Non-Therapy RUGs with High ADLs, Change of Therapy Assessments, Ultra High Therapy RUGs and 90+ Day Episode of Care
  • Review of sample ADL coding
  • Education on Medicare coverage criteria and regulatory requirements which enables the clinical team to document properly and to be prepared for all levels of medical record inspection
  • Development of a Quality Assurance Performance Improvement process to review, investigate and monitor targeted areas

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