Frequently Asked Questions

Interpretation and Use of PEPPER

The PEPPER team is not able to provide a listing of patients related to the PEPPER target areas; however, providers should be able to identify those patients using the same claims inclusion/exclusion criteria and the target area numerator definition (both of which can be found in the PEPPER user’s guide). Please review this detailed reference for additional guidance and information (PDF, July 2017).

The values on the Compare Targets report under the headings “National %ile”, “Jurisdict. %ile” and “State %ile” are not percent values. They represent the provider’s percentile within the nation, Medicare Administrative Contractor (MAC) jurisdiction and the state for that particular target area for the most recent time period of that PEPPER. The values on the Comparative Data for Target Proportion table of the target area graph report (short-term acute care hospital) and the Comparative Data table of the target area report (LTCH, CAH, IPF, IRF, Hospice, HHA, PHP, SNF settings) are the percents (or rates) that are at the national, jurisdiction and state 80th percentile and the national, jurisdiction and state 20th percentile (for coding-related target areas) thresholds for that particular target area for that time period. The Compare Targets report is the only place in PEPPER where a provider can see its national, jurisdiction and state percentile for the most recent time period of each target area.

There may be time periods and in some cases entire data tables that do not display any data. The Centers for Medicare & Medicaid Services (CMS) data restrictions prevent the display of numerators and denominators with values that are less than 11. This is related to privacy concerns to prevent the implicit identification of Medicare beneficiary admissions/treatment.

No or very little DRG data on the Hospital Top Medical DRGs for Same- and One-day Stay Discharges, Hospital Top Surgical DRGs for Same- and One-day Stay Discharges reports for a short-term acute care hospital PEPPER (and similar "Top" reports for LTCH, CAH, IPF, IRF, Hospice, PHP, SNF and HHA PEPPERs) would indicate that there were fewer than 11 discharges (or episodes) for any one DRG (or the applicable category for other types of PEPPERs) for the time period of the report. CMS data restrictions prevent the display of discharge/episode counts that are less than 11. This is related to privacy concerns to prevent the implicit identification of Medicare beneficiary admissions/treatment.

MACs and RAs are not provided with PEPPERs; however, they are able to generate PEPPERs for providers in their jurisdictions/regions using the First-look Analysis Tool for Hospital Outlier Monitoring (FATHOM).

PEPPER includes the 80th percentile outlier boundaries and 20th percentile outlier boundaries (coding-focused target areas only) for all time periods for all three comparison groups so hospitals can compare their target area percents with all three comparison groups. Currently national-level data for all provider types and state-level data for short-term acute care and critical access hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, hospices, home health agencies, hospices and skilled nursing facilities are available on our Data page. Jurisdiction-level data are not available. PEPPER statistics are considered sensitive information; therefore, provider data cannot be shared.

PEPPERs are distributed to short-term acute care hospitals, long-term acute care hospitals, critical access hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, hospices, partial hospitalization programs, skilled nursing facilities and home health agencies. See the Distribution page for the current distribution schedule and delivery method. PEPPER is available to providers free of charge through a contract with CMS.

As an example, the short-term acute care hospital PEPPER version Q1FY18 includes reportable data from Q2 FY 2015 (second quarter of the federal fiscal year 2015) through Q1 FY 2018 (first quarter of the federal fiscal year 2018). The federal fiscal year begins October 1 and ends September 30. The PEPPER version Q1 FY 2018 (named based upon the most recent time period in the report) summarizes data for hospital discharge dates (paid, inpatient claims) from January 1, 2015 (Q2 FY 2015), through December 31, 2017 (Q1 FY 2018). For subsequent releases of ST PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added.

For other types of PEPPERs (LT, CAH, IPF, IRF, Hospice, SNF) which summarize three federal fiscal years, the reference to “Q4FY17” indicates that the most recent quarter of data included in the report is the fourth quarter of federal fiscal year 2017. The HHA and PHP PEPPERs summarize three calendar years (January 1 – December 31); the reference to “Q4CY17” indicates that the most recent quarter of data included in the report is the fourth quarter of calendar year 2017. For subsequent releases of the PEPPER, the oldest year of statistics rolls off as the new year is added.

The MAC jurisdiction comparison group is comprised of all providers that submit their claims to that MAC for Medicare reimbursement. Your MAC jurisdiction can be identified on the “Purpose” page of your hospital’s PEPPER. Short-term acute care hospitals, critical access hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, hospices, skilled nursing facilities and HHAs can also identify their MAC jurisdiction by checking the Jurisdiction “Top” report in their PEPPER. To view a list of the MAC jurisdictions, which includes the number of providers in each jurisdiction in total and by state, please visit the Training and Resources page for your provider type. Note that providers in a state may be divided among a number of different jurisdictions.

Currently there are seven contractors performing as 12 MACs that process claims for all hospitals in the nation, and hospitals within a given state may submit their claims to a number of different contractors. For example, Medicare claims for short-term acute care hospitals in Texas are processed by Noridian Healthcare Solutions, Wisconsin Physician Services, First Coast Service Options, Palmetto GBA and Novitas Solutions. In developing PEPPER, CMS asked the PEPPER team to establish the jurisdiction comparison group according to MAC jurisdictions. Providers are classified into the MAC jurisdiction to which they submit their claims for Medicare reimbursement. The CMS website describes the MACs.

PEPPER Resources Portal Issues

In order to make PEPPER more convenient for providers to access, the PEPPER team designed and implemented a secure portal in the spring of 2014 with the permission of the CMS. The PEPPER Resources Portal can be accessed through the PEPPERresources.org website. From the PEPPERresources.org Home page, click on the word “distribution” in the header or select “Distribution Schedule – Get Your PEPPER” to locate the links to the PEPPER portal for several provider types.

PEPPER Resources Portal retrieval maps are only available for providers that receive their PEPPER through the PEPPER Resources Portal. The maps are not available for short-term acute care hospitals or inpatient psychiatric facilities or for inpatient rehabilitation facilities and partial hospitalization programs.

CMS and the PEPPER team consider the PEPPERs to be sensitive information and thus have established security measures to protect the reports from unauthorized access. Because a patient control number or a medical record number should not be publicly available, these two fields were selected to serve as a way to validate that a person attempting to obtain a PEPPER is with an authorized organization.

Patient control and medical record numbers that providers might utilize as validation codes are located on the UB04 claims forms in form locators 03a and 03b respectively. When contacting the business office to request assistance for obtaining this information, please make sure to specify that you need the information from paid claims or the remittance advice. You will need to identify the following in your request:

  • The UB04 claim forms for traditional, fee-for-service Medicare Part A beneficiaries (not Medicare Advantage, Medicare HMO or Medicare replacement).
  • The “from” or “through” date on the claim (it must be during the time period specified on the “PEPPER Distribution – Get Your PEPPER” page).
  • The numbers that are in the form locator fields 03a (patient control number) and/or 03b (medical record number).
    Note that some organizations have separate “medical record numbers” for the patient’s actual medical record and for the medical record number found on the claim form; therefore, it is important to obtain the medical record number from the claim form.

A provider’s PEPPER is considered sensitive data, and the PEPPER team must ensure that the individual trying to access the PEPPER is authorized to do so. We ask that providers obtain validation codes (a patient control number or a medical record number from paid claims or the remittance advice) as a way to verify their status with the provider. Some providers must use the provided validation code because their UB04 claim forms either 1) do not have patient control numbers or medical record numbers entered on the UB04, or 2) the values found in both of these fields appear to be patient names or portions of patient names (patient names cannot be accepted due to patient privacy laws). These providers will receive a message indicating that they must use the validation code provided by the PEPPER team, and they should request assistance with obtaining this validation code by going to the home page at PEPPERresources.org and submitting a request for assistance at the “Help/Contact Us” link. Other providers may receive the alternate validation code, though this may only occur after it has been ensured that the requestor is authorized to obtain the provider’s PEPPER.

The PEPPER team programmed the portal to safeguard the PEPPER; therefore, the screen will “time out” after 15 minutes. Upon accessing their PEPPER through the portal, providers should save their PEPPER to a location on their computers where they can access it in the future or share it with others within their respective organizations.

The PEPPER team is required to track response time to customer requests for assistance to the extent possible. The use of the electronic Help Desk (see Help/Contact Us at pepper.cbrpepper.org) enables the team to fulfil this responsibility. In addition, the majority of inquiries can be efficiently addressed with an email response. The Help Desk staff contact providers via telephone as requested or when the issue is more effectively addressed via discussion. In addition, assistance can be provided by calling the PEPPER Help Desk at 1-800-771-4430 from 9 a.m. until 5 p.m., Eastern Time, Monday through Friday.

The PEPPER team responds to all requests for assistance within two business days. When providers submit requests for assistance through the online Help Desk, they should immediately receive a confirmation email regarding their submission. The email responses from pepper@tmf.org may be blocked by your organization’s email system security. You should also receive email notifications from pepper@tmf.org responding to your question. Look for these emails to occasionally show up in your spam/junk folder. We recommend you add “@tmf.org” to your email Safe Senders List and contact your IT staff for any additional input.

Adding our Internet domain “@tmf.org” to your Safe Senders list in Outlook 2013/2010 can be accomplished by following these steps:

  1. On the “Home” menu, click the “Junk” menu under the “Delete” symbol at the top of the page.
  2. Choose the “Junk Mail Options” feature, choose the “Safe Senders” tab and click “Add.”
  3. In the “Enter an email address” or “Internet domain name to be added to the list” box, enter the name or address you want added, in this case “@tmf.org,” and then click “OK.”