SNF PEPPER Reports are here!!!

The SNF PEPPER Report summarizes a SNF’s Medicare claims data in areas that may be at risk for abuse or improper payment.  PEPPER compares a SNF’s claims data statistics with aggregate statistics for other SNFs in the state, MAC/FI jurisdiction and the nation.  SNFs with high billing patterns (at or above the national 80th percentile) are identified as “outliers” and are encouraged to ensure that they are complying with Medicare payment policy, that services provided to beneficiaries are medically necessary and that medical record documentation supports the services that are billed.

GPS Healthcare can evaluate your PEPPER Report and make recommendations, not only identifying risk, but undertaking an audit process to make sure MDS accuracy and medical necessity documentation issues are addressed.  Target areas include Therapy RUGs with High ADLs (11-16), Non-therapy RUGs with High ADLs, Change of Therapy (COTs) Assessments, Ultrahigh Therapy RUGs, number of total days in Therapy RUGs and any 90+ Day Episodes of Care.

The fee for the PEPPER Report review is $200 and includes a written report detailing outlier issues, identification of risk areas and self-audit opportunities as well as recommendations for operational and clinical changes based on the findings.

For more information contact: