At the end of August 2013, the Centers for Medicare and Medicaid Services (CMS) will issue reports to certified skilled nursing facilities via mail as part of its Program for Evaluating Payment Patterns Electronic Reporting (PEPPER) system. These reports will identify areas within a facility’s Medicare Part A payment system that are at risk for improper payment. The PEPPER reports will detail each facility’s Medicare Part A claim statistics for the areas CMS has determined as being at risk for improper payment.

Only facilities that have sufficient data to generate a PEPPER report will receive one. Facilities that do receive one should use the report to audit its own billing practices and work to improve their efficiency and accuracy in billing for Medicare Part A. CMS has noted that the PEPPER reports do not identify improper payments but rather only identify potential areas in the facility for improper payments.

The PEPPER reports will also compare the facility’s Medicare billing risks with the billing data of other facilities in the region. This statistic will provide further guidance in the facility’s assessment of its Medicare billing practices.

If you would like more information on the impact the PEPPER reports will have on your facility, contact one of DLM Legal’s health care attorneys at info@dlmlegal.com.