Posted Wednesday, June 30, 2021
If you are like most home health agencies across the country, there is less than a 50% chance you are using all the data available from CMS to ensure that your charges are in line with other HHAs.
Nothing will delay payment or trigger an audit more than requesting reimbursement that is out of line with your type of agency and your regional costs. But it doesn’t have to be that way. That data is readily available to you in the HHA PEPPER Report and knowing what it is showing can prevent you from being that outlier that attracts unwanted attention. The PEPPER Report gives you the inside track on whether your charges are in line with other HHAs in your area and across the country.
The PEPPER Report -or Programs for Evaluating Payment Patterns Electronic Report – analyzes the data from home health agencies across the country to identify utilization and reimbursement patterns in an effort to control costs and prevent fraud, waste and abuse. The analysis which the PEPPER Report generates is required by the Social Security Act to protect the Medicare Trust Fund. You should know how CMS is viewing your agency.
With all that valuable information just for the asking, it makes sense to grab your free PEPPER Report from the PEPPER Resources Portal. You will learn where you stand in relation to other HHAs regarding items such as comorbidity adjustments, admission source, and average case mix, for example. The PEPPER Report compares your submissions with those from your local jurisdiction, state and national counterparts. By crunching that data, CMS determines that any provider whose charges are above the 80th percentile is considered an outlier and can be subject to review and audit.
To avoid raising eyebrows with payers, it can pay to be proactive by downloading and reading the PEPPER Report for HHAs which becomes available to you on July 9. It’s easy to do. For information on how to get your PEPPER report, go to Distribution Schedule – Get Your PEPPER (cbrpepper.org). Or go right to the Pepper Resources Portal and submit your request at Home Page (cbrpepper.org). Your organization’s CEO, President, Quality Assurance Officer, Administrator or Compliance Officer can access the report with your agency credentials. For a quick tutorial on how to use the document, download the User’s Guide.
If you would like help accessing, reading and interpreting the data to ensure your agency makes the most of it, contact Corridor today at 1-866-263-3795.
For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.
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