Frequently Asked Questions

General Questions

What is PEPPER?

The Program for Evaluating Payment Patterns Electronic Reports (PEPPER) is an electronic report that delivers facility-specific Medicare statistics for discharges and services vulnerable to improper payments. PEPPERs encourage providers to review data about their billing practices to help ensure they submit accurate claims for payment. Facilities can use the PEPPER data to identify where they need to change billing practices, pinpoint areas in need of auditing and monitoring, identify potential Diagnosis Related Group (DRG) under- or over-coding problems, and identify target areas where length of stay is increasing.

How frequently do providers receive PEPPERs?

CMS distributes PEPPERs quarterly to Short-Term Acute Care Hospitals (STACHs) and annually to Long-Term Acute Care Hospitals (LTACHs), Critical Access Hospitals (CAHs), Inpatient Rehabilitation Facilities (IRFs), Home Health Agencies (HHAs), hospices, Inpatient Psychiatric Facilities (IPFs), Partial Hospitalization Program (PHP), and Skilled Nursing Facilities (SNFs).

What is Fiscal Year (FY) and Quarters?

For Medicare data, the fiscal year (FY) runs from October 1 through September 30. For example, FY 2025 is October 1, 2024 through September 30, 2025. Quarters are as follows:
Quarter 1 (Q1): October through December
Quarter 2 (Q2): January through March
Quarter 3 (Q3): April through June
Quarter 4 (Q4): July through September

What time period do PEPPERs cover?

The PEPPER displays all target areas for the most recent 12 quarters available.

Who is the CMS contractor that administers PEPPERs?

Index Analytics LLC, along with its partners Integrity Management Services, Inc. and GovCon Growth Solutions, develops and distributes PEPPER under contract with CMS.

PEPPER Target Areas

What are PEPPER target areas?

Each PEPPER contains statistics for areas identified as at-risk for improper payments, which CMS refers to in the report as target areas. Typically presented as percents, the numerator represents potentially problematic discharges, and the denominator represents discharges for a larger comparison group for a particular area of care. Each PEPPER type includes data on relevant target areas for that hospital or facility group. PEPPER presents data in tabular form and in graphs that depict the facility’s target area percentages over time.

How to Access and Download PEPPER

How do I access my PEPPER?

You may access your PEPPER files through a secure portal on the CMS CBR PEPPER website. New releases will occur on a quarterly basis for Short-Term Acute Care Hospitals (STACH) and annually for Long-Term Acute Care Hospitals (LTACH), Critical Access Hospitals (CAHs), Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), hospices, Partial Hospitalization Programs (PHPs), and Inpatient Rehabilitation Facilities (IRFs).

Interpretation and Use of PEPPER

Can I get a listing of patients included in the PEPPER numerator count?

The PEPPER Team cannot 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. (Refer to the PEPPER User Guide for more information about target areas.)

What does it mean if my facility is flagged as an outlier for a specific metric?

PEPPER determines outliers based on preset control limits. The upper control limit for all target areas is the 80th percentile. Coding-focused target areas also have a lower control limit, which is the 20th percentile. PEPPER draws attention to any findings that are at or above the upper control limit (high outlier) or at or below the lower control limit (low outliers) for coding-focused areas only. When interpreting the Compare Targets Report findings, facilities should consider their target area percentile values for the nation, jurisdiction, and state. Percentile values at or above the 80th percentile (for all target areas) or at or below the 20th percentile (for coding-focused target areas) indicate that the facility is an outlier. Outlier status should be evaluated in the following priority order: 1) nation, 2) jurisdiction, and 3) state. The state should have the last priority because it has the smallest comparison group.

Is my facility at risk of an audit if it is flagged as an outlier?

PEPPER does not identify the presence of payment errors, but facilities can use it as a guide for auditing and monitoring efforts. A facility can use PEPPER to compare its claims data over time to identify potential areas of concern, including significant changes in billing practices, possible over- or under-coding, and changes in length of stay.

Who is my facility data compared to in a PEPPER?

The Compare Targets Report displays the facility’s number of target discharges, percent, percentiles as compared to the nation, jurisdiction, and state, and the “Sum of Payments.”

Why is there no, or very little, data for some of the target areas on our PEPPER?

There may be time periods and, in some cases, entire data tables that do not display any data. CMS data restrictions prevent the display of numerators and denominators with values that are less than 11. This relates to privacy concerns to prevent the implicit identification of Medicare beneficiary admissions/treatment.

PEPPER Help Desk

I have questions about how to use the PEPPER. Who can I contact for help?

Do you have questions related to PEPPERs
• What is the PEPPER?
• What are the target areas?
• How can we use the PEPPER data to help prioritize areas for auditing and monitoring?
The PEPPER User Guide is now available to assist with your questions.
In addition, users authorized to access the PEPPER Provider Portal can submit a PEPPER help desk ticket once logged into the Portal.

Please contact the PECOS External User Services (EUS) help desk if you cannot log in to the Portal because your account is disabled, you have forgotten your User ID, or you need to modify your account to accurately reflect your Authorized Official or Individual Practitioner status.
PECOS External User Services (EUS) Help Desk:
Phone: 1-866-484-8049
Email: EUSSupport@cgi.com