Home Health & Hospice Week

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Know Your Facts: PEP Recoveries

If you bury your head in the sand on partial episode payment adjustments, you could find yourself buried in hundreds of thousands of dollars in PEP takebacks.

The regional home health intermediaries say here's where to check out your claims that will be subject to PEP recoupments (see story, this page). Access is available online through the Direct Data Entry system:

  • Cahaba GBA: Status/location SB0098. Reason code PEP01 will indicate the claims subject to PEP adjustments.

  • Palmetto GBA: Status/location SM PEP1. Home health agencies should make a printout of their affected claims since they will only be at this location until July 28. At press time, Palmetto agencies were seeing only a partial list of their PEPs and the RHHI was aware of the problem, a Palmetto spokesperson said.

  • United Government Services: Status/location SMPEPs. Reason code PEP01 will indicate the claims subject to PEP adjustments.

    RHHI Associated Hospital Service of Maine will withhold a flat 5 percent of payments per week rather than recouping based on individual claims, until an HHA's total PEP debt is paid back.

    More information on how to access the claims slated for PEP adjustments is included on intermediaries' Web sites and in their communications to providers.