Home Health & Hospice Week

HHAs lag in using government-supplied benchmarks.

If you think diving into your free PEPPER report is a waste of time, Medicare’s PEPPER contractor would like you to think again.

The PEPPER is an annual comparative data report that summarizes your Medicare claims data statistics “for areas prone to abuse/improper Medicare payments,” PEPPER contractor TMF Health Quality Institute explains in a series of releases offering case studies of how PEPPER reports have helped home health and hospice agencies (see story below). PEPPER report data, used properly, can “support providers’ efforts to identify and prevent improper Medicare payments,” TMF stresses.

Home health agencies’ PEPPER reports furnish benchmarking data on six high-risk areas: Average Case Mix; Number of Episodes; Episodes with 5 or 6 Visits; Non-LUPA Payments; High Therapy Utilization Episodes; and Outlier Payments. TMF first issued HHAs’ reports last year, and as of last November, only 24 percent of the nation’s HHAs had accessed their reports (see Eli’s HCW, Vol. XXV, No. 42).

Hospices’ PEPPER reports cover 10 high-risk areas: Live Discharges — Revocations; Live Discharges with LOS 61-179 Days; Claims with Single Diagnosis Coded; No General Inpatient Care or Continuous Home Care; Live Discharges No Longer Terminally Ill; Long Length of Stay; Continuous Home Care Provided in an Assisted Living Facility; Routine Home Care Provided in an Assisted Living Facility; Routine Home Care Provided in a Nursing Facility; and Routine Home Care Provided in a Skilled Nursing Facility. TMF started issuing hospice PEPPER reports in 2012, adding the SNF and ALF measures in 2015 and the Discharge, coding, and GIP/CHC measures last year (see Eli’s HCW, Vol. XXV, No. 11). As of last November, about 56 percent of hospices had accessed their reports, the Centers for Medicare & Medicaid Services said in an Open Door Forum.

Medicare provides benchmarking data for the target areas on a national, Medicare Administrative Contractor, and state level.

Resource: Access your PEPPER reports online at https://pepperresources.org.