SNF PEPPER Reports Are Available
FY 2025 PEPPER for skilled nursing facilities
CMS has released the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for skilled nursing facilities. If your facility has received its report, now is a good time to review the data and determine whether any findings warrant a closer look.
PEPPER provides facility-specific Medicare data and compares a facility's results with other providers. The report is designed to help identify billing patterns that may need additional monitoring, auditing or review.
Start With The Outliers
PEPPER identifies target areas using established comparison points. A facility may be identified as an outlier when its results fall at or above the 80th percentile for a target area. For coding-focused areas, the report also identifies low outliers at or below the 20th percentile.
An outlier is not automatically an indication of an error or improper billing. It is a reason to ask questions.
Look Beyond The Number
The most useful PEPPER review goes beyond identifying where a facility falls compared with its peers.
If a target area stands out, consider reviewing a sample of the underlying records and claims. Look for patterns in documentation, coding, medical necessity, length of stay or other factors related to the target area. PEPPER can also be reviewed alongside other information already available to the facility, including internal audit findings, billing trends and clinical documentation reviews.
Turn The Findings Into Action
PEPPER is most valuable when it becomes part of an ongoing monitoring process rather than a report that gets downloaded and filed away. Depending on the findings, the review may lead to additional auditing, staff education, documentation improvements or closer monitoring of a particular billing practice.
CMS notes that PEPPER is a tool to help providers prioritize areas for auditing and monitoring. It is not an audit itself, and the PEPPER team does not determine whether a specific claim was appropriate.
SNFs can access their FY 2025 PEPPER through the PEPPER Portal. CMS also provides a User Guide and other resources to help facilities interpret the report.
| Represents the HIPPS codes, TC, TD, TF, TG, TJ, TK, TN, or TO |
| Represents the HIPPS codes SC, SF, SI, or SL |
| Represents the Nursing HIPPS code representing the Nursing group: A, B, C, D, H, or L |
Additional coverage can be found on Park Place in the article PEPPER Review Time Is Here After CMS Release.
