Are Your Billing Practices Raising a Red Flag for Auditors? PEPPER Could Help
January 8, 2016 04:06 PM
Program for Evaluating Payment Patterns Electronic Report (PEPPER), which is sponsored by the Centers for Medicare & Medicaid Services (CMS), is a provider-specific Medicare data report that summarizes a provider’s Medicare claims data for services identified as vulnerable to improper payments.
The PEPPER is free and summarizes three years of an HHA’s Medicare billing practices, comparing them with other HHAs for the following six areas at risk for improper Medicare payments.
Average case mix
Average number of episodes
Episodes with five or six visits
Below is an example of the HHA PEPPER, which shows how one HHA’s billing and therapy practices compare with other HHAs. The agency depicted in the below graph has had an increase in high therapy utilization episodes over the past two years (depicted by the blue bars), and is now above the 80th percentile when compared to all HHAs in the nation, jurisdiction and state (the red lines represent the 80th percentile for these comparison groups). Could this be you?
The HHA PEPPER reports were release in July 2015. Presently, only 21% of home health agencies have accessed their PEPPER reports. The National Association for Home Care & Hospice urges agencies to review their PEPPER reports to geta heads-up on aberrant billing activity. It is an opportunity for all HHAs to self-monitor their billing practices, compare their activities with other HHAs across the nation and determine whether they are an outlier in their practices and possible subjects of special review by the Medicare claims auditors.
The Office of Inspector General, Recovery Auditors, Medicare Administrative Contractors and other federal contractors are mining Medicare claims data in an effort to identify providers that may be at risk for fraud, waste and abuse. Wouldn’t you like to know how your agency compares? Learn how to access your PEPPERthen visit the PEPPER Resources Portalto get your PEPPER now!
The CMS has contracted with TMF® Health Quality Institute to develop and distribute PEPPER. For more information, educational resources and training visit PEPPERresources.org.