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.
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.
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.
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.