Portion of Hospice PEPPERs to be Reissued
April 23, 2013 04:34 PM
TMF Health Quality Institute, the Centers for Medicare & Medicaid Services (CMS) contractor for the hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) has alerted the National Association for Home Care & Hospice (NAHC) that they have identified a problem in the recently-released Hospice PEPPER (see NAHC Report, March 7, 2013). As a result, about half of the PEPPER reports recently sent to hospices must be revised and reissued.
The target area definition for the “Live Discharges” target area was revised for episodes of service that ended July 1, 2012 and later in order to be compliant with CMS Change Request 7677, which introduced additional codes for hospices to use to indicate the reason a beneficiary was discharged alive. The programming code for calculating these statistics was correct. However, for episodes ending prior to July 1, 2012, TMF found an error in the programming code.
Instead of identifying hospice episodes of service with a length of stay of less than 25 days for beneficiaries who were discharged alive and with occurrence code 42 (date of termination of hospice benefit), the code identified episodes of service with a length of stay of less than 25 days for beneficiaries who were discharged alive or with occurrence code 42. The state, jurisdiction and national 80th percentiles are also incorrect. This affected statistics for fiscal years 2010, 2011 and 2012. The revised reports will be sent to 1,383 hospices via Federal Express within four to six weeks.
Any hospice having data in their recently-received PEPPER (version Q4FY12) for the “Live Discharges” target area report for any of the three time periods (FY 2010, 2011 or 2012) will receive a corrected PEPPER. If this report is blank (that is, there is no data reported for any of the three time periods for the “Live Discharges” target area), the hospice will not receive a corrected PEPPER. In addition, there are 33 hospices that originally received a PEPPER but after correcting the statistics TMF found these hospices do not have any data to report for either target area (Live Discharges and Long Length of Stay) for any of the time periods. These hospices will not be sent a corrected PEPPER, but will receive a letter notifying them of the issue and that there is not sufficient data to generate a corrected PEPPER.
TMF regrets the error and has committed to improving operations to prevent such occurrences in the future. If hospices have questions they should access the TMF PEPPER website where questions/requests for assistance may be submitted via the tab marked “Help/Contact Us”.