Eli's Hospice Insider

Published on Tue Dec 11, 2012 PDF

Some hospices receive corrected reports.

Not all hospices received a PEPPER report, but you should make sure you didn’t get overlooked in error. Otherwise you’ll lose access to the stats that reviewers and other authorities are using to potentially target your claims.

"Hospice PEPPER will not be available for every Medicare certified hospice provider," PEPPER contractor TMF Health Quality Institute explains in a recent question-and-answer set on the reports. "A Hospice PEPPER will not be available if the hospice does not have: eleven or more Medicare beneficiaries who were discharged alive with occurrence code ‘42’ and had a length of stay of less than 25 days for any of the cap years 2009, 2010 or 2011, or eleven or more Medicare beneficiaries who received greater than 180 days of service at the hospice within the respective cap year."

In other words: "This means that the hospice does not have a large volume of beneficiaries for either of these risk areas, which can be interpreted to mean that you are not at risk for improper Medicare payments in either of these areas," TMF explains.

And some hospices may have gotten data on one of the target areas but not the other, TMF clarifies. For example, if your report showed data for the Long LOS measure but not Live Discharges, "this means that your hospice did not have eleven or more Medicare beneficiaries who were discharged alive with occurrence code ‘42’ and had a length of stay of less than 25 days for any of the cap years 2009, 2010 or 2011," the contractor says in the Q&A set.

About 3/4 Of Nation’s Hospices Receive Reports

Of the 3,500 or so Medicare-certified hospices in the nation, only about 2,700 had enough data in the three cap years to receive a report, TMF reports.

Breakdown: "There are 1,386 hospices in the J11 Palmetto jurisdiction, 685 hospices in the J13 National Government Services jurisdiction, 102 hospices in the J14 NHIC jurisdiction and 499 hospices in the J15 CGS jurisdiction," TMF elaborates. Hospices can access a complete listing of the number of hospices included in each jurisdiction in total and by state at www.pepperresources.org/TrainingResources/Hospice.aspx -- click on the link to the report under "Jurisdictions."

In addition to the target areas for comparison, the reports also include top terminal conditions for the hospice and its jurisdiction. But if your conditions seem wacky, you may be one of the providers affected by a data output issue that resulted in an incorrect list. TMF is sending out corrected reports to those providers, it says.