Home Health & Hospice Week

Medicare’s PEPPER contractor is bringing out the big guns in its attempt to persuade hold-outs to view and use their data reports.

The HHS Office of Inspector General “plans to review compliance with the home health prospective payment system to determine whether home health agency (HHA) claims were paid in accordance with federal laws and regulations,” PEPPER contractor TMF Health Quality Institute says in an email to providers. “A prior OIG report found that one in four HHAs had questionable billing.”

Potential target: “PEPPER can support an agency’s compliance efforts by identifying where it is an outlier for … target areas,” TMF maintains. “It is an opportunity for all HHAs to self-monitor their billing practices, compare their activities with other HHAs across the nation and determine whether they are an outlier in their practices and possible subjects of special review by the OIG.”

The PEPPER reports give you your stats on average case mix; average number of episodes; episodes with five or six visits; non-LUPA payments; high therapy utilization episodes; and outlier payments. More information about the report is online at PEPPERresources.org.