Posted Friday, July 9, 2021
PEPPER Report Release Date: July 9, 2021
Any day that a home health agency can improve quality and compliance is a good day. Today is one of those days. CMS released PEPPER Reports for home health agencies which are rich with valuable data that can improve an HHA’s performance metrics.
For detail, check out the related Corridor blog which explains the Programs for Evaluating Payment Patterns Electronic Report (PEPPER). PEPPER analyzes Medicare payment data from the Medicare UB-04 collected over three years from home health agencies across the country to identify utilization and reimbursement patterns. Individual HHAs can use the report to find out if their reimbursement is in line with national, jurisdictional and regional patterns. By staying within agency norms for the country, an HHA reduces its chance of triggering an audit. Outliers, those whose metrics are in the 80th percentile or higher, could attract CMS attention.
The value of the PEPPER does not end with reimbursement information, however. In addition to tracking reimbursement patterns to detect payment outliers, the PEPPER identifies specific areas where HHAs can improve performance. For 2021, HHAs have nine target areas – up from six – that help CMS determine if your HHA maintains specific performance within normal ranges. (PEPPER Reports are developed for all types of providers including acute care hospitals, SNFs and more, and each type of report has different target areas with provider-specific metrics.)
The nine HHA target areas for 2021 are:
- Average case mix – sum of all case mix weight for all episodes in the reporting period excluding LUPA and PEP
- Average number of episodes – count of episodes and count of unique beneficiaries
- Episodes with 5 or 6 visits – count of episodes with 5 or 6 visits compared to all visits in the reporting period
- Non-LUPA payments – episodes paid that did not have a LUPA compared to all episodes paid
- High Therapy Utilization Episodes – count of episodes with 20+ visits compared to all paid visits
- Outlier payments – sum of dollar amount of outlier payments (with Value Code=17) compared to sum of dollar of total episodes paid
- Admission source – count of periods discharged from a defined institution within 14 days compared to count of all periods
- Low comorbidity – count of periods with one or more secondary diagnoses associated with higher resource use that are eligible for lower comorbidity adjustment compared to all periods
- High comorbidity – count of periods with two or more secondary diagnoses that interact with one another and qualify for a higher comorbidity adjustment compared to all periods
HHAs with one or more of these target areas designated as outliers (in the 80th percentile or greater) can implement interventions such as those shown in the table below to improve their performance.
TABLE: Examples of potential interventions based on PEPPER Report results.
||Mix of institutional or community
||Adjust your marketing to target a healthy mix of clients
||Characteristics of the patients your serve
||Explore additional markets to achieve a healthy mix of clients
|Case Mix/Number Episodes/Outliers
||Number of episodes, intensity of utilization
||Educate admission clinicians to capture all comorbidities that affect reimbursement
|Case Mix/ Number of Episodes/Outliers
||Coding based on individual patient needs and medical condition
||Customize service utilization based on specific needs and medical condition versus boiler plate coding (e.g., 3W9 for everyone regardless of condition)
What To Do Next
To get started, access your PEPPER Report today at Distribution Schedule – Get Your PEPPER (cbrpepper.org). For a better understanding of your results, check out the User’s Guide.
Need help accessing and interpreting your report? Click or call us at Corridor at 1-866-263-3795. We can work with you to apply the information in your PEPPER to your advantage by identifying areas for improvement and helping you to determine appropriate remediation.
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