Hello, everyone, and welcome to our Monday Minute.
Today we’re going to talk about the update that has just occurred to the Home Health PEPPER reports. PEPPER is a very important part of Home Health agency data. The analysis of that data is being conducted by third-party Medical Review contractors, as well as CMS, the OIG, and inclusive of your Medicare MAC. The PEPPER stands for the Program for Evaluating Payment Patterns Electronic Report. Those reports come directly from your claims data, so all of the data that is used in calculating the targets on your PEPPER reports come directly from your 30-day final claims. The PEPPER information is updated once a year. The Home Health information is specifically updated every July, hospice is in April.
The July 2022 update included that they have added two new targets specific to the PDGM model. One, the functional medium status of the patient, and the other functional high status of the patient. Basically, what’s happening here is they’re calculating the percentage to total of your 30-day payment period claims that are calculating as a functional medium status, the other of course, at a functional high status. Why would they be using these new targets? The targets are specifically calculated from claims data and compared to the National 80th percentile compared to your state’s 80th percentile and to your Medicare MACs jurisdiction’s 80th percentile. So basically, adding these new items with functional in your PDGM HIPPS code calculation, they’re comparing how many, or what percentage of your 30-day periods are calculating at a medium or high functional status as compared to the nation, the state, and jurisdiction.
It is imperative that agencies understand that the PEPPER report is one of the number one sources of data analysis for third-party Medical Review contractors and that you look at your data and understand exactly where you stand. Do understand that coming into 2022, they did change the point allocations for how the functional status is actually calculated. They did that so that less 30-day periods would wind up in the medium and high status than was the case in 2020 and the first part of 2021.
If you are in the top 20th percentile of agencies, as far as a very high percentage of patients with medium and high functional status, the concern from the CMS standpoint is we even changed the point allocations so that fewer periods would wind up in that category, and there might be medical review questions as to how you arrived there, with such a high percentage of charts.
Hopefully, this has been very informative. Today, we will give you the link to the PEPPER report site where you can obtain your PEPPER on that site. Also, know that there are lots of publicly reported data, and you don’t even have to log in yourself to obtain that. That publicly reported data includes information that is specific to agencies within your state, within the nation, and within the Medicare MAC jurisdiction. In some of the peer group data, actually comparing you to your peers based on rural versus urban, your ownership status, etc. So very much information. We have done a few Minutes and clips on the PEPPER reports and on our website, and you should be able to access those as well.
Thank you all for participating today. I hope to see you at a live conference this summer and fall. I’m scheduled to speak at tons of them so hopefully, we will be able to see you there. Have a great week and we will talk again next week.