Frequently Asked Questions

Interpretation and Use of PEPPER

TMF is not able to provide a listing of patients related to the PEPPER target areas, however providers should be able to identify those patients using the same claims inclusion/exclusion criteria and the target area numerator definition (both of which can be found in the PEPPER user’s guide). Please review this detailed reference for additional guidance and information (PDF, 10/23/2014).

The values on the Compare Targets reports under the headings “National %ile”, “Jurisdict. %ile” and “State %ile” are not the same as the values noted on the respective Comparative Data table of the target area report. Why is there a difference? The values on the Compare Targets report under the headings “National %ile”, “Jurisdict. %ile” and “State %ile” are not percent values. They represent the provider’s percentile within the nation, MAC jurisdiction and the state for that particular target area for the most recent time period of that PEPPER. The values on the Comparative Data for Target Proportion table of the target area graph report (short-term acute care hospital) and the Comparative Data table of the target area report (LTCH, CAH, IPF, IRF, Hospice, PHP, SNF settings) are the percents that are at the national, jurisdiction and state 80th percentile and the national, jurisdiction and state 20th percentile (for coding-related target areas) thresholds for that particular target area for that time period. The Compare Targets report is the only place in PEPPER where a provider can see its national, jurisdiction and state percentile for the most recent time period of each target area. View a demonstration (DOC, 12-10-2014) Compare Targets report, with associated hospital target area data and graph.

View a slide presentation (PPT, 7-11-2013) on percents and percentiles.

There may be time periods and in some cases entire data tables that do not display any hospital data. The Centers for Medicare & Medicaid Services (CMS) data restrictions prevent the display of numerators and denominators with values that are less than 11. This is related to privacy concerns to prevent the implicit identification of Medicare beneficiary admissions/treatment.

No or very little DRG data on the Hospital Top Medical DRGs for Same- and One-Day Stay Discharges, Hospital Top Surgical DRGs for Same- and One-Day Stay Discharges reports for a short-term acute care hospital PEPPER (and similar "Top" reports for LTCH, CAH, IPF, IRF, Hospice, PHP and SNF PEPPERs) would indicate that there were fewer than 11 discharges (or episodes) for any one DRG (or the applicable category for other types of PEPPERs) for the time period of the report. CMS data restrictions prevent the display of discharge/episode counts that are less than 11. This is related to privacy concerns to prevent the implicit identification of Medicare beneficiary admissions/treatment.

MACs and RAs are not provided with PEPPERs; however, they are able to generate PEPPERs for hospitals in their jurisdiction/region using the First-look Analysis Tool for Hospital Outlier Monitoring (FATHOM).

PEPPER includes the 80th percentile outlier boundaries and 20th percentile outlier boundaries (coding-focused target areas only) for all time periods for all three comparison groups so hospitals can compare their target area percents with all three comparison groups. Currently national-level data for all provider types and state-level data for critical access hospitals and skilled nursing facilities are available on our Data page. Jurisdiction-level data are not available. PEPPER statistics are considered sensitive information; therefore, hospital data cannot be shared with other hospitals.

PEPPERs are distributed to short-term acute care hospitals, long-term acute care hospitals, critical access hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, hospices, partial hospitalization programs and skilled nursing facilities. See the Distribution page for the current distribution schedule and delivery method. PEPPER is available to providers free of charge through a contract with CMS.

As an example, the short-term acute care hospital PEPPER version Q4FY13 includes reportable data from Q1 FY 2011 (first quarter of the federal fiscal year 20118) through Q4 FY 2013 (fourth quarter of the federal fiscal year 2013). The federal fiscal year begins October 1 and ends September 30. The PEPPER version Q4 FY 2013 (named based upon the most recent time period in the report) summarizes data for hospital discharge dates (paid, inpatient claims) from October 1, 2010 (Q1 FY 2011) through September 30, 2013 (Q4 FY 2014). For subsequent releases of ST PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added.

For other types of PEPPERs (LT, CAH, IPF, IRF, Hospice, PHP, SNF) which summarize three federal fiscal years, the reference to “Q4FY13” indicates that the most recent quarter of data included in the report is the fourth quarter of federal fiscal year 2013. For subsequent releases of the PEPPER, the oldest year of statistics rolls off as the new year is added.

TMF is contracted to provide PEPPERs to individual providers across the nation. The technical, security and confidentiality constraints of our distribution system do not allow us to send multiple PEPPERs to one entity, such as someone in a corporate system office. It will be up to each provider to determine how PEPPER is distributed internally within their facility or to a corporate office. Another option for providers that receive their PEPPER electronically through QualityNet is to work with each provider’s QualityNet Administrator to obtain a QualityNet basic user account (PEPPER recipient role and File Exchange and Search role) for each provider; you would then be able to receive those providers' reports. For information related to QualityNet please visit www.qualitynet.org.

Your MAC jurisdiction can be identified on the “Purpose” page of your hospital’s PEPPER. Short-term acute care hospitals, critical access hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, hospices and skilled nursing facilities can also identify their MAC jurisdiction by checking the Jurisdiction “Top” report in their PEPPER. To view a list of the MAC jurisdictions, which includes the number of providers in each jurisdiction in total and by state, please visit the Training and Resources page for your provider type. Note that providers in a state may be divided among a number of different jurisdictions.

Currently there are eight contractors performing as 12 Medicare Administrative Contractors (MACs) that process claims for all hospitals in the nation, and hospitals within a given state may submit their claims to a number of different contractors. For example, Medicare claims for short-term acute care hospitals in Texas are processed by Noridian Healthcare Solutions, Wisconsin Physician Services, First Coast Service Options and Novitas Solutions. In developing PEPPER, CMS asked TMF to establish the comparison groups according to MAC jurisdictions. Providers are classified into the MAC jurisdiction to which they submit their claims for Medicare reimbursement. The CMS website describes the MACs. CMS is planning to eventually consolidate the current MAC jurisdictions to a total of 10 A/B MACs. View a map of the 10 consolidated A/B MAC jurisdictions (PDF).

PEPPER Resources Portal Issues

In order to make PEPPER more convenient for providers to access, TMF Health Quality Institute designed and implemented a secure portal in the spring of 2014 with the permission of the Centers for Medicare and Medicaid Services (CMS). The PEPPER Resources Portal can be accessed through the PEPPERresources.org website. From the PEPPERresources.org Home page, click on the word “distribution” in the header or select “Distribution Schedule-Get Your PEPPER” to locate the links to the PEPPER portal for several provider types. Once a provider clicks on the button to access a portal, he/she will need to enter the provider’s 6-digit CMS Certification Number. The provider will also have to enter either a patient control number or a medical record number for a traditional, fee-for-service (FFS) Medicare Part A beneficiary (not a Medicare Advantage/managed care beneficiary) who was receiving services during a specified time period (see the “Distribution Schedule – Get Your PEPPER” page for details).

CMS and TMF Health Quality Institute consider the PEPPERs to be sensitive information and thus have established security measures to protect the reports from unauthorized access. Because a patient control number or a medical record number should not be publicly-available, these two fields were selected to serve as a way to validate that a person attempting to obtain a PEPPER is with the organization.

Patient control and medical record numbers that providers might utilize as validation codes are located on the UB04 claims forms in form locators 03a and 03b respectively. When contacting the business office to request assistance for obtaining this information, please make sure to specify that you need:

  • UB04 claim forms for traditional, fee-for-service Medicare Part A beneficiaries (not Medicare Advantage, Medicare HMO or Medicare replacement).
  • The “from” or “through” date on the claim must be between September 1-30, 2013 for PEPPER version Q4FY13 that was made available in the spring of 2014, and for PEPPER version Q4FY14, to be available in the spring of 2015, the "from" or "through" date on the claim must be between September 1-30, 2014).
  • The numbers that are in the form locator fields 03a (patient control number) and/or 03b (medical record number)
    Note that some organizations have separate “medical record numbers” for the patient’s actual medical record and for the medical record number found on the claim form; therefore, it is important to obtain the medical record number from the claim form.

A provider’s PEPPER is considered sensitive data, and TMF must ensure that the individual trying to access the PEPPER is authorized to do so. TMF asks that providers obtain validation codes (a patient control number or a medical record number) as a way to verify their status with the provider. Some providers must use the TMF-provided validation code because their UB04 claim forms either 1) do not have patient control numbers or medical record numbers entered on the UB04, or 2) the values found in both of these fields appear to be patient names or portions of patient names (patient names cannot be accepted due to patient privacy laws). These providers will receive a message indicating that they must use the validation code provided by TMF, and should request assistance with obtaining this validation code by going to the home page at PEPPERresources.org and submitting a request for assistance at the “Help/Contact Us” link. Other providers may receive the alternate validation code, but only after TMF has ensured that the requestor is authorized to obtain the provider’s PEPPER.

TMF programmed the portal to safeguard the PEPPER; therefore the screen will “time out” after 15 minutes. Upon accessing their PEPPER through the portal, providers should save their PEPPER to a location on their computer where they can access it in the future or share it with others within their organization.

TMF is required to track response time to customer requests for assistance to the extent possible. The use of the electronic Help Desk enables TMF to fulfil this responsibility. In addition, the majority of inquiries can be efficiently addressed with an email response.

TMF responds to all requests for assistance within two business days. When a provider submits a request for assistance through the Help Desk, they should immediately receive a confirmation email of their submission. If a provider does not receive a confirmation email they may need to check their junk email box and/or spam filter to determine if the Help Desk email has been blocked. In this case, the response from the Help Desk will be similarly blocked and not received. Should this be the case, the requestor can submit another request for assistance through the Help Desk and indicate that they have not received a response via email. The TMF team will contact the requestor to provide assistance.

QualityNet Portal Issues

PEPPERs are uploaded by an automated process to those at short-term acute care hospitals, critical access hospitals, inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs that are distinct part units of an acute care hospital), who are QualityNet Administrators and also to those who have the QualityNet basic user account (PEPPER Recipient role and File Exchange and Search role). If you received the file twice, you are a QualityNet Administrator and have the PEPPER Recipient role as well. The files are the same. You can download one, make sure it opens okay, and delete the other from your Secure File Transfer AutoRoute inbox if you wish. You will always receive two files if you have been assigned both roles (QualityNet Administrator and PEPPER Recipient). Alternatively, if you don't want to receive the file twice, you can maintain the QualityNet Administrator status and "unassign" the PEPPER Recipient role within the QualityNet Secure Portal.

You should work with your hospital’s QualityNet Administrator (this is the person who is usually involved in the reporting of your hospital’s quality data), who can assist you with completing the necessary paperwork to set up the basic user account (PEPPER Recipient role *and* File Exchange and Search role).

If you are with a short-term acute care hospital, critical access hospital, inpatient psychiatric facility, or inpatient rehabilitation facility that is a distinct part unit of an acute care hospital, and your hospital does not have a QualityNet Administrator, a QualityNet Administrator account must be created through the QualityNet Help Desk. Users must be individually approved and verified. You should contact the QualityNet Help Desk to request a QualityNet Administrator registration packet.

If you have not logged in to your QualityNet account for more than 120 days, your account may be locked “due to inactivity.” You will need to work with your hospital's QualityNet Administrator (this is the person who is usually involved in the reporting of your hospital's quality data) to submit an account reactivation request to the QualityNet Help Desk. If you were a QualityNet Administrator, another QualityNet Administrator at your hospital can submit the request. If there are no other QualityNet Administrators available at your hospital, then you will have to contact the QualityNet Help Desk at www.qualitynet.org.

We are unable to directly reset your QualityNet password. Contact your organization’s QualityNet Administrator to request a temporary password. If you do not have access to a QualityNet Administrator at your hospital, you will need to contact the QualityNet Help Desk.

After logging in to your account, click on “Secure File Transfer” at the top, then locate the “AutoRoute_inbox” and click on it. The PEPPER file should be in the inbox if your account was active at the time of the PEPPER file upload. Highlight it and click “Download.” Then select “Save” and it will want you to select a location on your computer (Desktop, etc.) where you want the file to be saved to. Select a location, then click “Save” and the file should then be downloaded to that location. Also you can refer to the PEPPERresources.org home page, hover over “PEPPER” at the top, then click on “Downloading PEPPER-QualityNet” for instructions with screen shots. If you had not downloaded your PEPPER from your QualityNet account inbox prior to the transition to the new QualityNet portal in July 2014, files that remained in the inbox were deleted at the time of the transition to the portal.

After logging in to your account, click on “Secure File Transfer” at the top, then locate the “AutoRoute_inbox” and click on it. The PEPPER file should be in the inbox if your account was active at the time of the PEPPER file upload. Highlight it and click “Download.” Then select “Save” and it will want you to select a location on your computer (Desktop, etc.) where you want the file to be saved to. Select a location, then click “Save” and the file should then be downloaded to that location. Also you can refer to the PEPPERresources.org home page, hover over “PEPPER” at the top, then click on “Downloading PEPPER-QualityNet” for instructions with screen shots. If you are still having problems downloading your PEPPER from QualityNet you can submit a request for help at PEPPERresources.org, see “Help/Contact Us” at the top of the home page.