Overview
This presentation will assist the NHA and clinical leaders to understand how to access the facility’s PEPPER (Program for Evaluating Payment Patterns Electronic Report). Only the NHA or the facility’s CEO, Compliance Officer or QAPI officer may access the facility’s PEPPER report. National SNF claims data was analyzed to identify areas within the SNF prospective payment system (PPS) that could be at risk for improper Medicare payment. The report shows how a SNF’s data compares to aggregate jurisdiction, state, and national statistics. Statistics in PEPPER are presented in tabular form and in graphs that depict the SNF’s target area percentages over time. All of the data tables, graphs, and reports in PEPPER were designed to assist SNFs with the identification of potentially improper payments.
The presentation will walk the NHAs through each of the 4 target areas, identify which scores are considered high risk or low risk for improper Medicare Payment which could trigger Medicare reviews. PEPPER does not identify the presence of improper payments, but it can be used as a guide for auditing and monitoring efforts. A SNF can use PEPPER to compare its claims data over time to identify areas of potential concern and to identify changes in billing practices. New target areas are found on the 2021 PEPPER due to the onset of the new PDPM Medicare payment system. Suggested interventions for each of the target areas to mitigate risk will be reviewed.
Learning Objectives:
1. Define why PEPPER was developed.
2. List 4 of the SNF Target areas reported by PEPPER.
3. Verbalize which PEPPER percentiles would be considered “at risk.”
4. List the 3 geographical areas to which the SNF’s percentiles will be compared.
Instructor
Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC
Carol Maher is a Board Certified Gerontological Registered Nurse with over 30 years of long term care experience and has worked in long term care in many roles. She worked as the MDS Coordinator in a 300 bed SNF in Pennsylvania for 8 years before moving to CA to become the MDS Coordinator/Director for a 1200 bed SNF in San Francisco. She has also worked as the MDS Coordinator in a SNF that typically had 60-75 residents on Medicare in addition to 160 long-term care residents. Most recently she was the Senior VP of Utilization Services and Director of Reimbursement for large multi-facility organizations.
Carol has worked as one of the Gold Standard nurses for MDS 3.0, serving on the RAP workgroup to prepare the way for the CAAs for MDS 3.0, and participating on a number of Technical Expert Panels related to MDS, Quality Measures and care planning. A sought-after speaker, she has given presentations at AANAC, AHCA and Leading Age national conferences as well as many state organization presentations. She is also a frequent author of articles related to the RAI process and PPS. Carol served as a member of the AANAC Board of Directors for 9 years. She is presently serving as the chair of the AANAC Expert Advisory Panel and as an AANAC Master Teacher of the RAC-CT and RAC-CTA certification courses. Ms. Maher is the Director of Education for Hansen Hunter & Co. P.C., providing MDS and Medicare classes across the country, presenting monthly educational webinars and completing compliance audits. She is the author of Long-Term Care MDS Coordinator’s Field Guide (HCPRO 2016).
Credit Hours
- 1 credit hours for RNs
- 1 credit hours for NABs
This pre-recorded webinar expires on May 27, 2023.