CMS RESUMES RELEASE OF SNF PEPPER REPORTS

The Centers for Medicare and Medicaid Services (CMS) Program for Evaluating Payment Patterns Electronic Report (PEPPER) furnishes provider-specific Medicare data statistics for discharges/services vulnerable to improper payments. PEPPER can support a facility’s compliance efforts by identifying where it is an outlier for these risk areas. This data can help identify both potential overpayments as well as potential underpayments. Earlier this year, CMS placed PEPPER report distribution on hold due to the COVID-19 pandemic. CMS has not directed the PEPPER contractor to resume PEPPER distribution and SNF reports will be issued on July 29, 2020 (originally scheduled release date: April 6, 2020).

While many of the PEPPER data elements in the report include legacy RUG-IV data, the PEPPER team has added a new target area “3- to 5-Day Readmissions” which identifies the percent of readmissions that occurred shortly after a 3-day gap of non-coverage. This data may be useful to establish a baseline for analyzing any changes in SNF discharge/readmission practices with the implementation of PDPM on October 1, 2019. As you are aware, CMS indicated that they were going to monitor the impacts of the new SNF PPS PDPM interrupted stay policy on SNF discharge/readmission patterns.

The updated SNF PEPPER user’s guide is here. Appendix 3 provides examples of how the new “3- to 5-Day Readmissions” are identified for the reports. Learn more about PEPPER here or subscribe to the PEPPER email list to receive updates on PEPPER training and reports.