Program for Evaluating Payment
Patterns Electronic Report

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Training & Resources for Skilled Nursing Facilities

PEPPER Resources

Training to help Skilled Nursing Facilities (SNF) use and understand PEPPER are under development. TMF will develop a recorded web-based training session in August, which will be made available on this website. In addition, a listing of target areas will be added.

Right click on the file names below and select "Save Target As..." to save to your computer. To receive updates on training and other resources, please join our email list.

Current PEPPER User’s Guide


  • View a list of the 12 MAC jurisdictions and the number of providers in each jurisdiction in total and by state for PEPPER Q4FY13 (56 KB XLS).
  • View a list of the 14 MAC/FI jurisdictions and the number of SNFs in each jurisdiction in total and by state for Q4FY12 (58 KB XLS).

PEPPER Training Update (May 2014):

PEPPER Training (August, 2013):

Demonstration PEPPER:

  • Demonstration PEPPER version Q4FY13 (572 KB XLS, updated 3/19/2014)

What is PEPPER?

The SNF PEPPER is a report that summarizes a SNF’s Medicare claims data in areas that may be at risk for abuse or improper payment. PEPPER compares a SNF’s claims data statistics with aggregate statistics for other SNFs in the state, MAC/FI jurisdiction and the nation. SNFs with high billing patterns (at or above the national 80th percentile) are identified as “outliers” and are encouraged to ensure that they are complying with Medicare payment policy, that services provided to beneficiaries are medically necessary and that medical record documentation supports the services that are billed.

PEPPER cannot identify the presence of improper payments; only a review of the medical record can determine whether services are medically necessary and appropriately billed.


View the distribution schedule.

Other Resources:

  • Refer to this document for guidance on how to create a listing of patients included in the PEPPER target areas (PDF).
  • View a list of the Skilled Nursing Facility target areas (PDF).
  • View this slide presentation (PPT file, updated 7-11-2013) on percents and percentiles to help understand the differences between “percent” and “percentile” and how they are used in PEPPER.
  • Audit tools shared with permission of Evergreen Rehabilitation Compliance Dept, Contact: Shawn Halcsik, VP of Compliance.
    • COT Audit tool (129kbs PDF or 11kbs Excel) − Audits completion accuracy of required COTs by comparing Therapy Documentation for RUG Supported and Claim Form for RUG billed
    • Section O Audit tool (31kbs PDF or 13kbs Excel) − Audits MDS section O accuracy by comparing minutes/modes supported in therapy documentation and minutes/modes reported on MDS
    • Triple Check (80kbs PDF or 14kbs Excel) − The triple check form is used at monthly IDT meeting to match the clinical aspects with the billing items to ensure Medicare compliance with billing and coding requirements as well as ensure technical components on claim form are accurate
  • Contact TMF through the Help/Contact Us page to request examples of Triple Check tools from Skilled Healthcare.
  • View a demonstration (Word file, updated 12-10-2014) Compare Targets report, with associated hospital target area data and graph.



Curious as to how the SNF PEPPER looks? View a SNF demonstration PEPPER version Q4FY13 (572 KB XLS, updated 3/19/2014).