Eli's Hospice Insider

Published on Tue Aug 21, 2012 PDF

If you haven't received it yet, you soon can expect a FedEx delivery that contains your hospice's statistics on long stays and live discharges.

Hospices will receive a Program for Evaluating Payment Patterns Electronic Report (PEPPER) in late August, PEPPER contractor TMF Health Quality Institute says on the PEPPER website. The report contains the same statistics that reviewers, authorities, policymakers, and others use.

"The Hospice PEPPER is a report that summarizes a hospice's Medicare claims data in areas that may be at risk for abuse or improper payment," TMF explains on the PEPPER site. "PEPPER compares a hospice's claims data statistics with aggregate statistics for other hospices in the state, MAC/ FI jurisdiction and the nation."

Red flags: "Hospices with high billing patterns (at or above the national 80th percentile) are identified as at risk for improper Medicare payments and are encouraged to ensure that they are complying with Medicare payment policy, that services provided to beneficiaries are medically necessary and that medical record documentation supports the services that are billed," TMF says.

Remember, having billing stats that are out of the norm doesn't automatically equal fraud and abuse. "PEPPER cannot identify the presence of improper payments," TMF says. "Only a review of the medical record can determine whether services are medically necessary and appropriately billed."

PEPPER reports will not be available to the public, TMF adds.

More information, including a User's Guide and sample report, are at http://pepperresources.org/TrainingResources/Hospice.aspx.