Hospices Will Receive New PEPPER in April 2013
Monday, March 25, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy




In April, hospices can expect to receive the second release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER). The Hospice PEPPER is a unique report provided free by the Centers for Medicare and Medicaid Services (CMS) that compares each hospice’s Medicare billing practices with those of other hospices in the state, the Medicare Administrative Contractor (MAC) jurisdiction and the nation. Its focus will be on claims that may be at risk for improper Medicare payments. Hospices can use the data to support internal auditing and monitoring activities.

CMS has contracted with TMF Health Quality Institute to develop and distribute the reports. The PEPPER will be delivered in hard copy format via FedEx addressed to the hospice CEO. Hospices will note the following changes in the PEPPER as compared with the first PEPPER release that was mailed in August 2012:
  1. This release (version Q4FY12) summarizes the three most recent federal fiscal years (FYs) of hospice claims data (FY2010, 2011 and 2012). The federal fiscal year runs from October 1 through September 30. The first release (version RY2011) summarized three hospice cap rate years (the cap year runs November 1 through October 31).
     
  2. TMF has made changes in the way hospice claims are evaluated for the reports. The first release reported on all services provided during each reporting year. This release reports on beneficiaries whose episode of service ends in the reporting year, whether by death or by live discharge. Because of these changes:
    • The “Live Discharges” target area counts include all episodes (instead of the most recent episode) where the beneficiary was discharged alive with a length of stay less than 25 days.
    • The “Long Length of Stay” target area counts beneficiary episodes of service that had a long length of stay (greater than 180 days) only in the time period in which the beneficiary was discharged or died (instead of in each time period during which the beneficiary received greater than 180 days of service, regardless of whether they were discharged or died).
       
  3. The definition of the “Live Discharges” target area was updated in compliance with CMS Transmittal 2410 Change Request 7677 for all episodes of service that end on or after July 1, 2012.
For more information, including training materials and a demonstration Hospice PEPPER, visit PEPPERresources.org. Hospice staff are encouraged to join the email list on this website to receive information about the upcoming PEPPER distribution and training opportunities.
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