In July of every year, the home health PEPPER report is subject to updates. This free resource is accessible online and can play an essential role in your internal compliance program in 2023.

And although a few weeks delayed, the latest updates have been released and are available on the PEPPER website. 

What is PEPPER?

PEPPER (Program for Evaluating Payment Patterns Electronic Report) is a valuable tool for home health agencies to use to improve their compliance with Medicare regulations and improve patient outcomes. It is an electronic report that provides a summary of provider-specific Medicare data statistics in target areas that may be at risk for improper Medicare payments. It is important to note that this report does not identify improper payments but only identifies the possible risks.

Why is the PEPPER report important for home health quality assurance?

Because of the findings in their PEPPER reports, many home health organizations have been subjected to increased medical reviews. This underscores the value of the report in identifying areas where home health organizations may be at risk for improper payments. 

Medicare has identified target areas that may be at risk for proper payments, and some of these target areas are:

• Low/high comorbidity

• Medium/high functional impairment level

• Average case mix

• Admission source

A high percentage in a target area might indicate a higher risk of erroneous billing, which your agency should look into. Being at or above 80% in a PEPPER target area puts your agency in an outlier category, which means a high risk of receiving improper payment.

Organizations that have targets exceeding the 70th percentile should carefully review their PEPPER data to identify areas that require focused quality assurance (QA) efforts. This will help to ensure that the organization is progressing in the right direction and avoiding surpassing the 80th percentile in future calculations, which could lead to increased medical review.

The PEPPER data can be used to develop QA plans that target specific areas of risk. For example, an organization that has a high number of targets exceeding the 70th percentile for patients with a certain diagnosis may want to develop a plan to review the coding and billing for those patients. The QA plan should also include steps to educate staff on the proper coding and billing procedures for those patients.

It is crucial for home health QA teams to have access to this data to identify areas that require focused QA efforts.  

How can home health agencies benefit from PEPPER data?

CEOs and administrators of home health agencies, CFOs, compliance officers, staff members in charge of quality improvement, and members of the health information management team might find it useful for tracking changes in billing practices, identifying areas of potential overpayments or underpayments, potential diagnosis-related group over-coding and under-coding, and other areas that can put their agencies at risk. 

Here are some of the benefits of using the PEPPER report for home health agencies:

• PEPPER can help agencies identify areas where their claims data may be out of line with the norm. This can help them identify potential areas for improvement, such as ensuring that they are only billing for services that were actually provided or that they are using the correct codes.

• The report can also be used to benchmark an agency's performance against other agencies in the same area. This can help them identify areas where they may be doing well or where they may need to improve.

• Agencies can reduce their risks and safeguard their patients' welfare as well as their bottom line by identifying the areas where they are vulnerable to improper payments.

• The PEPPER data can also be used to identify potential overpayments or underpayments. This can help agencies ensure that they are not overcharging Medicare for their services and that they are not missing out on any potential payments.

• The information in the PEPPER report can be used to make data-driven decisions about care delivery and to develop a new program or pathway of care for that type of patient.

Key Takeaways

Incorporating the report into the quality assurance and performance improvement program can be helpful in making an agency's risk reduction efforts stronger and raising the standards of care. This collaborative approach lets HHAs look at the report from different angles to understand it better and can also help them identify which specific clinicians may be in need of additional training and education, leading to better documentation and lowering associated risks.

Realizing the importance of PEPPER helps home health agencies find ways to improve care, streamline internal procedures, advance quality metrics, and reinforce financial stability. Looking closely at the report is particularly significant for the identification and preemptive resolution of potential billing issues, thus mitigating the need for CMS audits.  

This report provides an insightful perspective on an agency's operational dynamics, enabling targeted interventions in high-risk areas. Ignoring this self-assessment opportunity not only exposes the organization to vulnerabilities but also hinders the correction of problematic billing aspects.