2016 PEPPER Reports: Are You an OUTLIER?

The fourth round of PEPPER (Program for Evaluating Payment Patterns Electronic Report) was recently released for hospice providers. The first step after receiving the report is to review your scores and compare them against other agencies.

As you must know, the Hospice PEPPER report summarizes a hospice agency’s Medicare claims data in areas that may be at risk for abuse or improper payment. The report compares the hospice claims data statistics with aggregate statistics for other hospices in the state, MAC/FI jurisdiction and the nation. It determines whether you have been identified as an outlier at risk for improper payments.

Note: If your Target Areas are at or above the 80th percentile, or at or below the 20th percentile, depending on the area, you can be called an outlier.

If your PEPPER shows you are an outlier, an internal audit should be conducted to identify any improper payments or non-compliant practices. The CMS mentions that variances from the national data do not necessarily mean billing irregularities have occurred. Although, agencies should know whether there is a reason why the government has identified you as an outlier.

Hospice agencies must incorporate PEPPER data into their compliance auditing strategy, as this would help identify potential areas of non-compliance.

Note: Good PEPPER should not give you false confidence about your claims – it is a good practice to conduct documentation reviews to ensure claims are appropriate, even if you aren’t an outlier.

PEPPER is a powerful compliance tool that tells providers how the government sees them. This should be the first step for providers to take when planning an audit strategy.

You can download your PEPPER, by:

  1. Visiting the PEPPER Resources Portal
  2. Enter your information
  3. Download your PEPPER

On Thursday, June 9, expert speaker Susan Balfour will be discussing the 2016 PEPPER reports. Join her to get insights on the high cost of ignoring PEPPERs and even higher cost of downloading it and ignoring it.

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