Situation Report | August 2, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) has made available for download the latest Home Health Program for Evaluating Payment Patterns Electronic Report (PEPPER) in the PEPPER Portal.
PEPPER summarizes Medicare claims data statistics for a provider in “target areas” that may be at risk for improper Medicare payments, and compares the provider’s Medicare claims data statistics with aggregate Medicare data for the nation, Medicare Administrative Contractor (MAC) jurisdiction, and the state.
While the PEPPER cannot identify improper payments, it does help a provider to identify areas where its performance falls outside the norm and payments may be at risk.
There are three new target areas for home health this year and the target area for High Therapy Utilization Episodes was deleted. Also deleted were the Top Diagnoses Report and Top Therapy Episodes Report. A Top Clinical Groups Report was added. These changes were made to align the target areas and reports with the new risks associated with the Patient Driven Groupings Model (PDGM).