What is a PEPPER report?
PEPPER stands for the Program for Evaluating Payment Patterns Electronic Report. PEPPER reports summarize Medicare claims data for a provider in “target areas” that may be at risk for improper Medicare payments. PEPPER compares a provider’s Medicare claims data statistics with combined Medicare data for the nation, jurisdiction, and the state. PEPPER is an educational tool that is intended to help providers assess their risk for improper Medicare payments. While PEPPER reports started as a report pushed out to providers, it is now the responsibility of the organization to pull the report, which is available on PEPPER Resources.
PEPPER Target Areas
PEPPER target areas are identified as potentially at risk for improper Medicare payments (e.g., coding or billing errors, unnecessary admissions/services).
| Coding-Focused | Admission-Focused |
| Simple Pneumonia | Total Knee Replacement (Added with the Q3FY20 Release) |
| Septicemia | 30-Day Readmissions to Same Hospital or Elsewhere |
| Unrelated OR Procedures | Two-Day Stays for Medical DRGs |
| Emergency Department Evaluation and Management Visits | One-Day Stays for Medical DRGs |
For a complete listing of PEPPER target areas, visit PEPPER Resources.
How can providers take advantage of the data PEPPER reports offer?
- To assist hospitals with monitoring short stays, several target areas in PEPPER focus on one-and two-day stays. Hospitals should examine their statistics for these target areas to help assess their risk for unnecessary admissions and to monitor changes in admission practices over time.
- PEPPER does not identify the presence of payment errors, but it can be used as a guide for auditing and monitoring efforts. A hospital can use PEPPER to compare its claims data over time to identify areas of potential concern such as:
- Significant changes in billing practices
- Possible over-or under-coding
- Changes in lengths of stay
PEPPER reports were developed as a compliance tool, but the data provided can also assist in revenue cycle optimization and integrity.
Have questions about the PEPPER report? Contact the Office of Healthcare Compliance and Privacy.
