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Home Health Agencies to Receive Comparative Data Reports

The U.S. Centers for Medicare and Medicaid Services (CMS) has made available, beginning July 20, provider-specific comparative data reports for Home Health Agencies.

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes claims data statistics for areas that may be at risk for improper Medicare payments. PEPPER is a free report comparing an agency’s Medicare billing practices with other agencies in the nation, Medicare Administrative Contractor (MAC) jurisdiction, and state. Agencies can use the data to support internal auditing and monitoring activities. Claims statistics include:

  • Average case mix
  • Average number of episodes
  • Episodes with 5 or 6 visits
  • Non- Low Utilization Payment. Adjustment (LUPA) payments
  • High therapy utilization episodes
  • Outlier payments

CMS has contracted with TMF Health Quality Institute to develop and distribute the reports. The reports are available as of July 20, via the PEPPER Resources Portal at: https://securefile.tmf.org/Default.aspx?ReturnUrl=%2f .

HCA members can review a User’s Guide (at  http://pepperresources.org/Portals/0/Documents/PEPPER/HHA/HHA_PEPPERUsersGuide_Edition1.pdf) for details on accessing the report.

Additional information is at http://www.pepperresources.org/.

A WebEx training session introducing and reviewing the PEPPER is scheduled for July 30; for more information, visit the Training and Resources website at: http://pepperresources.org/Training-Resources/Home-Health-Agencies.

For further information, contact HCA’s at (518) 810-0661 or pconole@hcanys.org.

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