Get Your PEPPER – Catch Medicare Red Flags Early and Identify Operational Opportunities
Unlocking Medicare Insights: Discover Risks and Opportunities with PEPPER Reports
PEPPER is available and it’s not for your plates! Released annually and available for agencies to download, the Process for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes provider-specific data for Medicare services that may be at risk for improper payments. We know that many agencies are not taking advantage of this report. According to the PEPPER website, only 33% of home health agencies and 57% of hospice agencies are downloading their report. Are you one of these agencies?
Your agency needs to review the PEPPER to identify areas of risk for improper Medicare payments and to identify operational opportunities! Keep reading to understand what you will gain from the report, how to download it, and FAQs. Meet with an expert sooner to discuss what opportunities you may be missing.
Why You Need to Review This Report
The PEPPER report can help agencies in several ways, including:
- Identifying areas of risk for improper payments. The PEPPER report provides data on Medicare payments for specific services. This data can be used to identify areas where an agency’s billing, coding, or operational practices may be putting them at risk for an audit or investigation.
- Benchmarking both locally and nationally. The PEPPER report also provides both state and national benchmarking data. This data can be used to see how an agency’s payment patterns compare to other agencies in the same region or with similar patient populations. This information can be used to identify areas where an agency may be able to improve their efficiency or profitability.
- Identifying opportunities for improvement. The PEPPER report can also be used to identify opportunities for improvement. For example, an agency may not be scoring the OASIS accurately which is leading to more patients receiving a Low or Medium Functional Impairment Level score as opposed to a High Functional Impairment Level score.
These are the three biggest reasons it is important to review your PEPPER report carefully and take steps to mitigate any risks identified. Keep reading to understand PEPPER and remember that our experienced consultants can help you interpret the data and develop corrective action plans.
About the PEPPER Report
The PEPPER report is released annually, 2. HHAs should review their PEPPER report carefully and take steps to mitigate any risks identified.
This report can be complex and time-consuming to review. Having a professional help you with this process can save you time to focus on your staff and patients and will ensure you accurately identify any risks to plan for a more efficient and compliant future.
PEPPER summarizes OASIS and ICD-10 Coding information reported on Medicare claims such as the percentage of periods receiving payment adjustments due to comorbidity and functional impairment levels. Visit utilization information is available from the information on the number of periods at, or one visit above, the LUPA threshold, non-LUPA payments, and average visits by Clinical Grouping; all of which are helpful in evaluating how resources are being utilized.
Read success stories of how peers have used their PEPPER report.
FAQs about the PEPPER report:
What is the PEPPER report?
The PEPPER report is a tool that can help HHAs identify areas where they may be at risk for improper Medicare payments. The report provides provider-specific data statistics for Medicare services that may be at risk for improper payments.
When is the PEPPER report released?
The PEPPER report is released annually for home health and hospice agencies, and the full schedule can be found here.
Who should review the PEPPER report?
The PEPPER report should be reviewed by the management team of any HHA that receives Medicare payments. The report can help identify areas where the organization may be at risk for improper payments and help develop corrective action plans.
What should I do if I have concerns about my PEPPER report?
If you have concerns about your PEPPER report, you should contact your Medicare Administrative Contractor (MAC). The MAC can help you understand the data in your report and develop a plan to address any concerns.
How can I get help with the PEPPER report?
There are a number of resources available to help you understand and use the PEPPER report. You can find a user’s guide, training materials, and FAQs on the PEPPER website. You can also contact us for help with reviewing and interpreting your PEPPER report.
How SimiTree Can Help
SimiTree’s team of consulting experts are here to help you protect your organization from improper payments ensure that you are in compliance with Medicare regulations – and identify opportunities! We are ready to help your team:
- Conduct a gap analysis between your PEPPER report and your internal compliance program
- Develop and implement a risk mitigation plan
- Train your staff on PEPPER and compliance best practices
We are here to help you protect your organization from improper payments and ensure that you are in compliance with Medicare regulations.
CLICK NOW to learn more about how we can help you with your PEPPER report.