Interpretation and Use of PEPPER
- The values on the Compare Targets reports under the headings “Hospital National %ile”, “Hospital Jurisdict. %ile” and “Hospital 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 “Hospital National %ile”, “Hospital Jurisdict. %ile” and “Hospital State %ile” are not percent values. They represent the hospital’s percentile within the MAC jurisdiction, the state and the nation 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 worksheet (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, jurisdictional and state 80th percentile and the national, jurisdictional 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 hospital can see its national, jurisdictional and state percentile for the most recent time period of each target area. View a demonstration (Word file, updated 10-01-2011) Compare Targets report, with associated hospital target area data and graph.
- Where can I find more information to help me understand the difference between “percent” and “percentile”?
View a slide presentation (PPT file, updated 7-11-2013) on percents and percentiles.
- Why is there no data, or very little data, for some of the target areas on our PEPPER?
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. Our understanding of the CMS restriction is that it is related to privacy concerns, to prevent the implicit identification of Medicare beneficiary hospital stays.
- Why is there no or very little DRG data showing on our Hospital Top Medical DRGs for Same- and One-Day Stay Discharges, Hospital Top Surgical DRGs for Same- and One-Day Stay Discharges reports?
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. New CMS data restrictions prevent the display of discharge/episode counts that are less than 11. Our understanding of the CMS restriction is that it is related to privacy concerns, to prevent the implicit identification of Medicare beneficiary hospital stays.
- Are MACs or RACs given access to individual hospital PEPPERs?
MACs and RACs 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).
- It would be helpful to have complete data files for the MAC jurisdiction and state to allow our hospital to run its own data comparisons. Can this be done?
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.
- Where can I find PEPPERs, and are they free?
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.
- The PEPPER file name displays as “Q4FY13,” and the most recent time period in the report is noted as Q4 FY 2013. What does the reference to Q4 FY 2013 mean?
As an example, the short-term acute care hospital PEPPER distributed in August, 2011 includes reportable data from Q3 FY 2008 (third quarter of the federal fiscal year 2008) through Q2 FY 2011 (second quarter of the federal fiscal year 2011). The federal fiscal year begins October 1 and ends September 30. The PEPPER version Q2 FY 2011(named based upon the most recent time period in the report) contains data for hospital discharge dates (paid, inpatient claims) from April 1, 2008 (Q3 FY 2008) through March 31, 2011 (Q2 FY 2011). 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.
- How can I get my short-term (ST) acute care hospital’s data for PEPPER versions Q1FY09 and Q2FY09?
There were no PEPPERs generated for Q1FY09 and Q2FY09. The final ST PEPPER version Q4FY08 was released in January 2009 by TMF Health Quality Institute (TMF) under the now defunct Hospital Payment Monitoring Program (HPMP). That release contained data through Q4 FY 2008. TMF negotiated a new contract with CMS’ Office of Financial Management to continue developing and distributing the PEPPER, and the initial PEPPER release in 2010, which does contain some changes in target areas, was distributed in February 2010. There were no PEPPERs developed and distributed during the interim. Each ST PEPPER released will include the most recent 12 federal fiscal year quarters, and the first version released under this new contract, named Q3FY09, included discharges from Q4 FY 2006 through Q3 FY 2009. For subsequent releases of ST PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added. The ST PEPPER User’s Guide, located on the Training & Resources page, contains detailed information describing what types of claims are included in ST PEPPER, definitions of the target area numerators and denominators and specifications for the DRG reports.
- Can I receive the PEPPERs for several providers within our system?
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) at each provider; you would then be able to receive those providers' reports. Visit our QualityNet Accounts page for more information.
- What is my MAC jurisdiction, and how many hospitals are included in the MAC and state comparison groups?
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 hospitals 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.
- I know there are more than 15 hospitals in Texas; however, the "Jurisdiction" listing for Q1FY14 indicates this is the number of hospitals in Texas for the J5 Wisconsin Physician Services jurisdiction. Can you explain?
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 file).
- Where is the Secure PEPPER Portal located?
In order to make PEPPER more convenient for providers to access, TMF Health Quality Institute designed and implemented the Secure PEPPER Portal in the Spring of 2014, with the permission of the Centers for Medicare and Medicaid Services (CMS). The Secure PEPPER Portal is located on the PEPPERresources.org website, and contains PEPPERs for providers that do not have access to QualityNet. To locate the portal at PEPPERresources.org from the Home page, hover over the drop-down menu under the “PEPPER” tab and then click on the “Secure PEPPER Access” to locate the PEPPER portal for several provider types. There is a Secure PEPPER Access user's guide that provides screen shots and step-by-step directions on how to access PEPPERs through the portal. 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 beneficiary (not a Medicare Advantage/managed care beneficiary) who was receiving services in September 2013 (the "from" or "through" date on the claim must be between September 1-30, 2013), to authenticate portal entry.
- Why do I have to spend time looking for a patient control number or medical record number to validate access to the PEPPER portal?
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 offices to request assistance for obtaining this information, please make sure to specify that you need:
- 1. UB04 claim forms for traditional, fee-for-service Medicare beneficiaries (not Medicare Advantage, Medicare HMO or Medicare replacement).
- 2. The “from” or “through” date on the claim must be between September 1-30, 2013.
- 3. 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.
- Can’t you provide me with the alternate validation code?
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.
- Isn’t there a telephone number that I can call to request assistance from Help Desk staff?
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.
- I sent in a Help Desk request and never received a 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.
- The portal times out after 15 minutes while reviewing the PEPPER.
TMF programmed the secure PEPPER 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.
- Why did I receive the PEPPER file twice? Which one should I download?
PEPPERs are uploaded by an automated process to those at short-term, some long-term, critical access hospitals, inpatient psychiatric and rehabilitation facilities (IPFs and 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 My QualityNet 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 "un-assign" the PEPPER Recipient role within My QualityNet.
- How can I get set up with a My QualityNet account to receive PEPPERs?
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). Please check the “PEPPER Recipient ” and “File Exchange and Search” boxes on the form when selecting roles.
If you are with a short-term acute care hospital, critical access hospital, or inpatient psychiatric or 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 your hospital’s state Quality Improvement Organization (QIO). A directory of all QIOs is available on the QualityNet website. Users must be individually approved and verified. You should contact your QIO to request a QualityNet Administrator registration packet. Instructions for completing and submitting the packet are available on our QualityNet Accounts page. Once your completed registration materials have been received by the QIO, the QualityNet Administrator there will enter your registration information and forward the original registration materials to the QualityNet Help Desk. You will be notified by e-mail when the registration process is complete and the My QualityNet (the secure portion of the QualityNet) website is accessible. The e-mail will also contain your User ID. The QIO's QualityNet Administrator will notify you of your initial password.
- My ‘My QualityNet’ account has been deactivated due to non-use; how can I re-activate it?
If you have not connected to My QualityNet for more than 120 days, then 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 re-activation 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 your state’s QIO and work with the QIO's QualityNet Administrator to submit the request.
- I forgot my password to get into My QualityNet. Can you help me reset my password so I can get the PEPPER?
Unfortunately, we are unable to directly reset your My QualityNet password. Your first option is to click on the “Forgot Your Password?” link on the My QualityNet sign-in page. Enter your user ID and e-mail address and click “Submit”. You will need to answer three of the randomly selected security questions to receive a temporary password via e-mail. If this process does not work, or your account is locked, you will need to 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 a QualityNet Administrator at your state’s QIO.
- When I log in to My QualityNet I don’t see the PEPPER.
When you log in to My QualityNet, click on the Exchange Files "Send/Receive" link, and at your inbox, you may see a name you don’t recognize (example: “Dan McCullough”) under the From column, “Auto Route Delivery” under the Subject column and a date such as “08/23/2011” under the Date Received column. After clicking once on that row, it turns yellow and you should be able to see the PEPPER file name below, an Excel file that begins with your hospital Medicare provider number (currently referred to as the CMS Certification Number (CCN)) and has the format xxxxxx_yyyyy_xtPEPP_qxFYxx_hospitalname.xls, with xxxxxx as the provider number and yyyyy indicating the MAC/FI jurisdiction. Click in the box to the left of the PEPPER file name and click the Download button in the lower left-hand corner. A message will pop up warning you that if you proceed you will overwrite any file on your computer with the same name; answer “YES,” then choose a folder or location where you want the file to be downloaded, and click “Save.” The PEPPER file should then be saved to your computer.
- I am having trouble downloading the PEPPER.
View instructions for downloading PEPPER, which include the following resources:
a. Step-by-step downloading instructions (PDF)
b. November 2010 information from QualityNet regarding My QualityNet Configuration Changes (PDF)
c. Proxy/Firewall and Uploading/Downloading Troubleshooting Tips (PDF)
Although Java 1.5 meets the minimal configuration requirements from QualityNet, Java version 1.6 or higher works best for the download process.