Home Health & Hospice

First round of home health PEPPER reports now available

Homecare Insider, July 27, 2015

The first ever home health edition of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for agencies to download via the free billing resource’s dedicated portal.
PEPPER was first introduced in 2003 for short-term acute care hospitals. In 2009, TMF Health Quality Institute 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 newly-released 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.
This first edition provides 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 considers:
1.      Outlier payments
2.      Average number of episodes
3.      Average case mix
4.      Episodes with five or six visits
5.      Non-LUPA payments
6.      High therapy utilization episodes
Experts say that home health agencies can use the report to bolster internal monitoring and evaluation activities, flag potential problems in their billing practices, steel themselves for scrutiny come audit time, and understand their position within the greater home health landscape.
To access their organization’s PEPPER, agency CEOs, presidents, administrators, or compliance officers should:
  1. Obtain the information required to authenticate access through the PEPPER Resources Portal (i.e., the agency’s CMS certification number and a medical record or patient control number from a traditional Medicare Part A fee-for-service claim that corresponds to services provided sometime during December 2014).
  2. Access the PEPPER Resources Portal, and complete all necessary fields on the form that appears.
  3. Click “Submit” at the bottom of the page to download the agency’s PEPPER. 
For the latest report updates, visit the home health training and resources page on PEPPERresources.org.
Beacon Institute members can access HCPro’s in depth coverage of the new home health billing report in the April 2015 issue of Homecare DIRECTION, a premier monthly newsletter for home health and hospice providers.