Newest PEPPER for Hospices Now Available
The newest hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) was released in early April from the RELI group along with its partners TMF Health Quality Institute and CGS, under contract with CMS. PEPPER has been available for hospices since 2012 and provides critical statistics spanning more than three years of Medicare claims data. PEPPER is intended to provide hospices with a guide for auditing and monitoring potential areas of concern and help identify potential areas at risk for improper payment.
Each individual hospice’s data is compared to national, jurisdictional, and state statistics for each targeted area. Targeted areas above the upper control limit of 80 percent and below the lower control limit of 20 percent indicate additional review is warranted to understand the contributing factors for the specific results and determine if further steps are needed to mitigate potential risk. Hospices have 12 targeted areas reported by PEPPER, including the new Average Number of Part D Claims per Hospice Episode, which is available as of the Q4 fiscal year 2020 release.
This new target area uses both Medicare hospice and Part D claims to identify patients who may be receiving drugs during episodes of hospice care that were paid for under Medicare Part D that should have been paid for by the hospice as part of the Medicare hospice benefit. Hospices whose PEPPER data is within range of the high-risk mark of the 80th percentile are encouraged to conduct a sample of their beneficiary records to help ensure processes are in place to adequately assess medication regimes and ensure the hospice is providing all medications related to the terminal prognosis as part of the hospice benefit.
Individual hospices receive only their data, which is available through the PEPPER portal. It should be noted that the PEPPER team does provide a Microsoft Access database referred to as FATHOM, the First-Look Analysis Tool for Hospital Outlier Monitoring, to the Medicare Administrative Contractors and recovery auditors for data mining. Hospices are encouraged to take advantage of the data provided in their PEPPER to evaluate and implement processes to safeguard against improper payments.
Access your PEPPER today here. BKD can help you evaluate your data and recommend strategies to mitigate risk in these targeted areas. Balancing quality, compliance, and cost is an ongoing challenge where BKD can serve as your trusted advisor.
For more information, reach out to your BKD Trusted Advisor™ or submit the Contact Us form below.