PEPPER, some of you have absolutely no idea what I’m talking about or why we’d be talking about PEPPER today, but PEPPER is a data analysis report that both Home Health and Hospices should be very familiar with, because they have become the leading source of data that is being used by medical reviewers to determine whether Home Health and Hospices should receive additional medical review audits. The Program for Evaluating Payment Patterns Electronic Reports, believe it or not, is what that acronym, PEPPER, stands for.
The PEPPER Reports are gathered by a third-party entity and grouped into reporting that is updated annually. The PEPPER Reports are data that comes directly from your claims data. For Home Health, nothing else impacts it, not OASIS, for Hospice, HIS has no impact.
The only data that is used on the PEPPER Reports comes directly from the final claims that you are following for reimbursement. That data is then calculated, multiple targets for both Home Health and Hospice.
– The Home Health targets were updated following the implementation of PDGM in 2020. As a result of the PDGM implementation, many of the items that were being calculated on the PEPPER Reports were no longer necessary, didn’t make any sense, because PDGM changed all that. So those have been updated, they are updated every July.
– For Hospice, they added one new target in 2021, which is specific to monitoring the Part D drugs, or the episodes that your patients that are in Hospice are actually still receiving drugs that are being paid for under the Part D benefit.
So, both PEPPER Reports, Home Health and Hospice, have both received updates in the last few months and continued to be updated annually with Hospice having their annual update each April. In the calculation of these targets within the reports, once the percentages or the target calculation is made for each of them, they are compared to the national 80th percentile of the Nation. Basically, if your numbers are higher than the National 80th percentile, that means that your scores are higher than 80% of the Nation. I think if you really think about it, that most of you would understand if your scores are higher than 80% of the other Home Health agencies in the Nation, or higher than 80% of all the rest of the hospices in the nation, that you would understand CMS might have some concerns, depending on which of the targets we’re talking about, of course.
Agencies that find themselves with multiple targets, especially in that arena where you are scoring in the 80th percentile or higher, are typically going to find themselves within just a few short months under medical review, whether it’s Targeted Probe and Educate an OIG review, a UPIC Audit, etc.
It’s imperative that if you don’t know what I’m talking about, that someone within your organization immediately obtains access to the PEPPER Reports and begins to analyze exactly where your agency stands in regard to the data within those reports. If you’re not looking at them, you’re making a huge mistake, because everyone out there that you don’t want to look at your data are looking at your PEPPER Reports. As always, Healthcare Provider Solutions can assist you in any way, please let us know. 615-399-7499 or info@healthcareprovidersolutions.com