Medicare News
New Release of PEPPER for CAHs, IPFs, and Hospital-Based IRFs, PHPs and SNFs
The Q4FY14 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER), with statistics through September 2014, has been made available the QualityNet secure portal for:
- Critical Access Hospitals (CAHs),
- Inpatient Psychiatric Facilities (IPFs),
- Inpatient Rehabilitation Facility (IRF) distinct part units of short-term acute care and critical access hospitals,
- Partial Hospitalization Programs (PHPs) administered by short-term acute care hospitals or IPFs, and
- Skilled Nursing Facility swing-bed units that are administered by short-term acute care hospitals.
About PEPPER
PEPPER summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. Visit PEPPERresources.org to access updated resources for using PEPPER, including recorded web-based training sessions, sample PEPPERs and PEPPER User's Guides, which are available on the applicable "Training and Resources" pages.
**Coming Soon** - PEPPER will be available for Home Health Agencies in July, 2015. Visit the Home Health Agency Training and Resources page at PEPPERresources.org for more information. Join our email list to receive information about the new Home Health Agency PEPPER.
PEPPER is distributed by TMF® Health Quality Institute under contract with the Centers for Medicare & Medicaid Services.
New Release of PEPPER for SNFs
The Q4FY14 release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Skilled Nursing Facilities (SNFs), with statistics through September 2014, is now available for download. To obtain the PEPPER, the Chief Executive Officer, President or Administrator of the organization should:
1. Review the Secure PEPPER Access Guide.
2. Review the instructions and obtain the information required to authenticate access. A new validation code will be required (medical record number or patient control number from a claim for services from September 1, 2014 through September 30, 2014).
3. Visit the PEPPER Resources Portal.
4. Complete all the fields.
5. Download the PEPPER.
The PEPPERs will be available to download for approximately two years. Note: SNF/swing bed units of short-term acute care hospitals received their PEPPER via the QualityNet secure portal.
Spring has sprung and so have our 2015 Medicare Symposiums!
Join us, live and in-person, as we discuss what is new and exciting with Medicare. Topics this year include Medicare Secondary Payer (MSP), provider enrollment, and modifiers. Don’t miss your chance to interact with the Novitas Solutions Provider Outreach and Education team!
Register today to attend our upcoming symposium in Albuquerque, NM on Wednesday, April 22! This event will be held at the DoubleTree by Hilton Albuquerque.
Registration is available for other symposium events and more locations are still to come!
Registration closes two business days prior to the event, so register early to reserve your seat!
We look forward to seeing you at an upcoming symposium event!
Important Credit Balance News
Any Credit Balance 838-Certifications that are not accurate and complete will be deemed invalid. Effective for the 03/31/15 reporting quarter, the immediate return of invalid or incomplete CMS-838 Certification Pages will result for the following reasons and please note that invalid Certification Pages will invalidate your entire submission:
- The incorrect version of the CMS-838 Certification Page/Detail Page is received. Please use the correct version of the CMS-838 Credit Balance Report. You can type directly into this version which is strongly encouraged to ensure your report is legible. Once completed in full, the report should be printed for signatures.
- Proper 6-digit Provider Transaction Access Number (PTAN) is missing, invalid, or a National Provider Identifier (NPI) is listed.
- The name of the facility is missing.
- Multiple PTANS are present. Only one PTAN per Certification Page is acceptable
- Incomplete or inaccurate Quarter Ending date. Quarters should be reported as 03/31/XX, 06/30/XX, 09/30/XX or 12/31/XX. Four digit years will also be acceptable.
- Signature and date of Administrator is missing
- Correct “Check One” block is blank or does not match the contents.
How to Complete the CMS-838 Credit Balance Reports
