Training & Resources for Skilled Nursing Facilities

Free-standing skilled nursing facilities and skilled nursing facilities that are part of another type of hospital receive their PEPPER via PEPPER Resources Portal at View a map of SNF PEPPER retrievals by state.

Skilled Nursing Facilities/swingbeds that are part of a short-term acute care hospital receive their PEPPER via QualityNet Portal at

View information on how to download your PEPPER via QualityNet Portal.

To receive updates on training and other resources, please join our email list.

Current PEPPER User’s Guide

PEPPER Training Sessions

  • May 2022 SNF PEPPER Review: This webinar reviews the PEPPER for Skilled Nursing Facility, version Q4FY21, released in early April, 2022. This webinar includes the history/background of PEPPER, a high-level review of the target areas, a walk-through of a sample PEPPER, and guidance for accessing the PEPPER. Download the PowerPoint slides (PDF), transcript (PDF), or Q&As for this PEPPER update.
  • Access a complete series of PEPPER training sessions, available as “chapters” for ease of access. A review of a sample SNF PEPPER is also available.
  • New PEPPER Format: This session reviews changes to the PEPPER for greater accessibility, cleaner presentation and improved readability. Download the PowerPoint slides (PDF) or the transcript (PDF) for this PEPPER recording.

Data Resources

  • National Target Area Analysis
  • SNF Target Percent Boundaries for Free-standing SNFs and Short-term Acute Care Hospital SNFs
  • State Target Area Analysis
  • Peer Group Bar Charts

Demonstration PEPPER:

  • Demonstration PEPPER version Q4FY21 (XLSX)


  • View a list of the 12 MAC jurisdictions and the number of providers in each jurisdiction in total and by state for PEPPER Q4FY21 (XLSX).

SNF PEPPER Testimonials

Other Resources:

  • Refer to this document for guidance on how to create a listing of patients included in the PEPPER target areas (PDF).
  • Access the (SNF) Medicare Claims Processing Manual (PDF)
  • View this slide presentation (PPT, updated 7-11-2013) on percents and percentiles to help understand the differences between “percent” and “percentile” and how they are used in PEPPER.
  • View a demonstration (DOC, updated 12-10-2014) Compare Targets report, with associated hospital target area data and graph.
  • Audit tools shared with permission of Evergreen Rehabilitation Compliance Dept, Contact: Shawn Halcsik, VP of Compliance.
    • COT Audit tool (PDF or Excel) − Audits completion accuracy of required COTs by comparing Therapy Documentation for RUG Supported and Claim Form for RUG billed
    • Section O Audit tool (PDF or Excel) − Audits MDS section O accuracy by comparing minutes/modes supported in therapy documentation and minutes/modes reported on MDS
    • Triple Check (PDF or Excel) − The triple check form is used at monthly IDT meeting to match the clinical aspects with the billing items to ensure Medicare compliance with billing and coding requirements as well as ensure technical components on claim form are accurate


When: Tuesday, April 11, 2023,  3 – 4 p.m. EDT
What: A WebEx presented by the RELI Group
Topic: This webinar will include the history/background of PEPPER, a high-level review of the target areas, a walk-through of a sample PEPPER, and guidance for accessing the PEPPER

Registration is required.


This program is being brought to you at no charge.

Because registration is limited to 1,000 sites, SNFs are encouraged to coordinate internally to prevent duplicate registrations and to allow as many SNFs as possible to participate. Registrants will receive an email with information about how to join the session.

For those unable to participate, the session will be recorded and posted here.

Handout: Download the handout. It will also be available avia WebEx upon joining the session.