PEPPER.CBRPEPPER.org is the official site for information, training and support related to the Program for Evaluating Payment Patterns Electronic Report (PEPPER).

What is PEPPER?

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a Microsoft Excel file summarizing provider-specific Medicare data statistics for target areas often associated with Medicare improper payments due to billing, DRG coding, and/or admission necessity issues. Target areas are determined by the Centers for Medicare & Medicaid Services (CMS). PEPPER facilitates the prioritization of areas on which a hospital or facility may want to focus auditing and monitoring efforts. Hospitals and facilities are encouraged to conduct regular audits to ensure that medical necessity for admission and treatment is documented and that bills submitted for Medicare services are correct.

PEPPER can be used to review three years of data statistics for each of the CMS target areas, comparing performance to that of other hospitals or facilities in the nation, specific Medicare Administrative Contractor (MAC) jurisdiction and state. PEPPER can also be used to compare data statistics over time to identify changes in billing practices, pinpoint areas in need of auditing and monitoring, identify potential DRG under- or over-coding problems and identify target areas where length of stay is increasing. PEPPER can help hospitals and facilities achieve CMS’ goal of reducing and preventing improper payments.

PEPPER was developed for short-term acute care hospitals in 2002 in support of CMS’ Hospital Payment Monitoring Program. State Quality Improvement Organizations (QIOs) began distributing PEPPER to the short-term acute care hospitals in their state in 2003. PEPPER was developed for long-term acute care hospitals in 2005. In 2008 QIOs were no longer responsible for working to reduce the improper Medicare fee-for-service error rate, and the Hospital Payment Monitoring Program ended. In 2010, Since then CMS began providing PEPPERs to all providers in the nation.

In 2011 PEPPER was developed for critical access hospitals, inpatient psychiatric facilities and inpatient rehabilitation facilities.

In 2012 PEPPER was developed for hospices and partial hospitalization programs.

In 2013 PEPPER was developed for skilled nursing facilities.

In 2015 a PEPPER was developed for home health agencies.

How you can benefit from PEPPER?

PEPPER is a tool that benefits various healthcare providers by offering detailed insights into Medicare billing patterns and identifying potential areas of improper payments. It allows users to access tables and graphs displaying billing activity over time, compare their data with other hospitals or facilities, and track changes in billing practices and Medicare reimbursement. It helps identify areas of potential overpayments and underpayments, as well as DRGs with high proportions of short-stay outliers. PEPPER also assists in monitoring length of stay data, reviewing high-risk target areas for improper payment, and prioritizing areas for auditing and compliance monitoring. The report supports efforts to improve medical record documentation, monitor readmission rates, assess admission necessity, and enhance case management and discharge planning. Additionally, PEPPER helps identify potential DRG coding issues, improve coding compliance, and can be used for educational and training activities. Overall, PEPPER serves as a valuable resource for improving financial accuracy, compliance, and care quality within healthcare organizations.

Success stories: How your peers have used their PEPPER Go to Success Stories