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08/24/2012

PEPPER Report Spices Things Up for Hospice Providers


MCA has received several phone calls regarding the PEPPER Report.  Hospices’ in Ohio have or will soon be receiving the Program for Evaluating Payment Patterns Electronic Report (PEPPER).

Many have received these via Federal Express, to the CEO’s attention, and must be signed for. It is a free report which is provided through the Centers for Medicare & Medicaid Services, and includes hospice-specific data statistics for Medicare services that may be at risk for improper Medicare payments.


What is PEPPER:

It is a report with hospice-specific claims data that has been identified as having the greatest potential and vulnerability for improper Medicare payments.  The report looks at claims from November 1, 2008 through October 31, 2011.


Interpreting PEPPER:

Hospices should review the reports and focus on areas where they are at greatest risk (at or above the 80th percentile).   PEPPER does not identify that improper payments have occurred only that it is a great risk and that certain billing practices may differ from the majority of other hospices.  A review of medical record documentation would need to occur to confirm if improper payment has occurred.  So, if a hospice falls into the 80th percentile it might suggest that they should expect an audit at some point in the future.


Training / Education for PEPPER:

The Hospice web-based training scheduled for Thursday, September 13 from 1:00 - 2:30 CT is full. The session will be recorded and the recording will be available on this website by September 27.

A Hospice PEPPER Q&A Session is scheduled for Thursday, Oct. 4, 1:00 - 2:00 pm CT.  Call either 719-325-4908 or 877-718-5108 and use Participant passcode 4303581#.  There is no need to register to participate.

 
Additional INFORMATION:

MCA has pulled together a number of resources for Hospices here in one location.

  • An OHIO Review from Hospice Analytics specifically identifying what areas PEPPER is targeting. Click here to access the report.
    • This includes an estimate based on Hospice Analytics, of how many hospices will be affected in Ohio at the 80thpercentile:
      • Live Discharges with LOS < 25 Days = 16 Ohio Hospices
      • LOS > 180 Days = 10 Ohio Hospices
      • Ohio Hospices in the 80th percentile in both categories = 2
    • Hospices at the 70thpercentile:
      • Live Discharges with LOS < 25 Days = 19 Ohio Hospices
      • LOS > 180 Days = 21 Ohio Hospices
  • Detailed PEPPER guide published by TMF Health Quality Institute (Group that is contracted by CMS to prepare the PEPPER Report.)  Click here to access the PEPPER User Guide.
  • Additional information is posted on the PEPPER website, where hospices can find a listing of the areas at risk for improper Medicare payments and a sample comparative data report.  Hospices can also join the email list to ensure that you receive information about the upcoming PEPPER distribution and training opportunities.