Home Health & Hospice

Home health agencies will soon have access to a new billing tool

Homecare Insider, March 30, 2015

NOTE: The following article is adapted from a feature story that appears in the upcoming (April 2015) issue of Homecare DIRECTION, HCPro’s premier monthly newsletter for home health and hospice providers. The full version of the article, which offers an in-depth explanation of the new billing report and expert tips for incorporating its findings into agencies' compliance programs, will be available to Beacon Institute members online later this week. To access the full version and other exclusive benefits, become a member of the Beacon Institute today.  

In July, CMS contractor TMF Health Quality Institute will release the first edition of the Program
for Evaluating Payment Patterns Electronic Report (PEPPER) for the home health industry—a resource characterized by its unrivaled offering of free, comparative billing data in a growing number of settings along the care continuum.
The report was first introduced in 2003 for short-term acute care hospitals. In 2009, TMF began contracting with CMS to broaden the report’s reach to include all acute care hospitals. Over the years, TMF has also adapted the report for a number of diverse healthcare settings, including hospices, critical access hospitals, inpatient rehabilitation facilities, and skilled nursing facilities.
Each setting’s PEPPER is composed of multimedia billing data (e.g., graphs, tables, and text) distributed over a number of tabs in a Microsoft Excel workbook. In terms of scope, the report pulls key information from the claims of Medicare beneficiaries whose discharges or episodes of care were completed within a reporting period that encompasses the three previous federal fiscal years (FY). A slight variation for the impending home health report: Keeping with the setting’s typical regulatory timeline, the home health PEPPER will be based on the calendar year (CY), with the first edition summarizing claims for CY 2012 to CY 2014.
The first edition of the home health report will provide detailed comparisons of an agency’s Medicare claims data in six domains considered at potential risk for abuse or improper payment to that of counterparts in the same state and Medicare Administrative Contractor (MAC) jurisdiction, as well as the country at large. Specifically, the report will consider:
  1. Outlier payments
  2. Average number of episodes
  3. Average case mix
  4. Episodes with 5 or 6 visits
  5. Non-LUPA payments
  6. High therapy utilization episodes
Experts say that home health agencies will be able to use the report to flag potential problems in their billing practices, steel themselves for scrutiny come audit time, and understand their position within the greater home health landscape.
However, despite the unique billing insights it promises to offer home health agencies, PEPPER has received scant publicity in the sector thus far, though the knowledge dearth appears to be shrinking. TMF recently announced a free education session that will be held on Thursday, April 30, at 11 am Central Time to discuss what’s changed in this year’s report editions for certain settings (including hospices, which will be evaluated in four additional target areas) and to reveal a preview of the first home health PEPPER.
For more information about TMF’s upcoming presentation, click here.
For the latest report updates, visit the home health training and resources page on PEPPERresources.org.