Hello, everyone, and welcome to our Monday Minute.
Today we’re going to discuss the hospice PEPPER reports. I know that recently, there was a clip that was in replacement of the Monday minute in my absence that was specifically addressing the PEPPER reports. Because of the questions that we have been receiving since the PEPPER update for hospice, I want to go deeper into the hospice PEPPER today.
I am going to share a screen with you today to review some of this information to ensure that we are all on the same page. The hospice PEPPER, as you see, stands for the Program for Evaluating Payment Patterns Electronic Reports. You have the link at the bottom of your screen that will take you to the PEPPER reports if you have not accessed those before, or even if you have and forgot. Within the PEPPER reports, you find the targets that you see listed on the screen now. Each of these targets are individually calculated based solely on the claims data that you provided with your monthly claims that you bill to Medicare 100%. From those clients, nothing else that you submit through HIS or any other data is used in the calculation of your PEPPER targets.
One of the big questions has become the Medicare Part D element that was added to the PEPPER just last year. That Medicare Part D element is being heavily scrutinized right now. In fact, with the April 2022 update to hospice, they segregated that actual calculation to include Medicare Part D when a patient is in hospice at home, a Medicare patient is in hospice in an ALF, or when a Medicare patient is on hospice and receiving those services in a nursing facility. They are really honing in on exactly what elements of Medicare Part D are still in play even though a patient is currently receiving the hospice benefit. You are going to want to see where your number falls in that realm and look internally at what you should and should not be worried or concerned about, as far as the elements that you should be providing to your patients, in the form of drugs that might have been paid for by the Medicare Part D fund, outside of the hospice benefit. This is just two of the targets. I just wanted to show you this screen to show you that within the target, or the PEPPER file itself, it gives you each one of the targets and an explanation of the numerator and denominator.
Lastly, this screen gives you a quick snap picture of one of the target elements. As you can see, you have data for all three years: 2018, 2019, and 2020. The one that was just released this year would have had 2019, 2020, and 2021. Understanding that each percentage of these targets is calculated. As you can see in 2020, this agency score was 28.7% for long length of stay compared to the National 80th Percentile of 25.6%. This agency is higher than that number, which puts them in an area of data analysis that might drive the reviewer to believe that the agency needs a deeper dive. As far as medical review is concerned, the PEPPER reports are indeed instrumental in helping the medical reviewers determine whether an agency should be targeted or not. Just because your numbers are above the National 80th Percentile does not necessarily mean that you’re going to be targeted. There is a high probability that will be the case if your numbers are higher than the 80th percentile.
I want to thank you all for participating today. Hopefully this gave you a little more insight into exactly what the PEPPER reports look like and how you are to look at that data. It is extremely important and I hope that you’re not one of the 40% of hospices in the nation that have not yet reviewed their reports. I hope you have a fabulous week and we look forward to seeing you at a live conference soon.