Q4FY19 PEPPER Now Available for Download

SNF PEPPER summarizes data statistics which are obtained from paid SNF Medicare UB-04 Claims for SNF episodes of care that end in the most recent three federal fiscal years (the federal fiscal year spans October 1-September 30). The current version of PEPPER now available reviews episodes of care through quarter 4 of FY2019 including statistics for 2017, 2018, and 2019. SNFs are compared to other SNFS in three comparison groups: nation, MAC, and state. These comparisons enable a SNF to determine if their results differ from other SNFs and whether it is an outlier and/or at risk for improper payments.

Target Area Updates

The following RUGs focused target areas will be phased out for FY2020 as a result of PDPM: Therapy RUGS with High ADL, Nontherapy RUGs with High ADL, Change of Therapy Assessment, & Ultrahigh Therapy RUGS. These target areas are included in the current FY2019 report along with the target areas: 20-day episodes of care, 90+ day episodes of care, and a new target area: 3-5 day readmissions which reviews readmissions to the SNF following a 3-5 calendar day gap. Please note this target area will not reflect claims until FY2020 and is intended to give providers information on readmission practices before and after PDPM implementation in order to assess the level to which facilities “may attempt to circumvent interrupted stay rules.”

Please click here for a table of target area definitions and suggestions.