Hospice PEPPER Available for Download

The annual Hospice PEPPER (Program for Evaluating Payment Patterns Electronic Report) is now available for download. PEPPER is a data report that contains a single hospice’s claims data statistics (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC)) for areas targeted by CMS as being at risk for improper Medicare payment.

Each hospice receives a PEPPER, which contains statistics for these target areas, regardless of whether the hospice’s data are of concern. The report shows how a hospice’s data compares to national, MAC jurisdiction and state statistics for the three most recent years.

Hospices can use the PEPPER to see how they compare to others in each of these target areas.  The PEPPER also includes suggested interventions that hospices could consider when assessing their risk for each of the target areas.

The target areas for this year’s pepper are:

  • Live Discharges No Longer Terminally Ill
  • Live Discharges – Revocations
  • Live Discharges LOS 61 – 179 Days
  • Long Length of Stay
  • Continuous Home Care Provided in an Assisted Living Facility
  • Routine Home Care in Assisted Living Facility
  • Routine Home Care in Nursing Facility
  • Routine Home Care in Skilled Nursing Facility
  • Claims with Single Diagnosis Coded
  • No General Inpatient Care or Continuous Home Care
  • Long General Inpatient Stay

NEW target areas this year:

  • Average Number of Medicare Part D Claims for Beneficiaries Residing at Home
  • Average Number of Medicare Part D Claims for Beneficiaries Residing in an Assisted Living Facility
  • Average Number of Medicare Part D Claims for Beneficiaries Residing in a Nursing Facility

NAHC suggested that a target area related to the Part D claims per hospice episode be included in the PEPPER as hospices did not have access to this information elsewhere. The target area – Average Number of Part D Claims per Hospice Episode – was added to last year’s PEPPER and expanded this year to include the Part D claims data for patients residing in various sites of care.  Therefore, the more general target area added last year was removed this year.

The PEPPER must be downloaded by each hospice.  It will not be mailed.  It is available electronically at the PEPPER Resources Portal.  An updated PEPPER User’s Manual is available at www.PEPPERResources.org under the Hospices tab.

RELI Group, the PEPPER contractor for the Centers for Medicare & Medicaid Services (CMS), will hold a webinar on Tuesday, May 17, 3:00 – 4:00 PM Eastern Time that will include the history/background of PEPPER, a high-level review of the target areas, a walk-through of a sample PEPPER, and guidance for accessing the PEPPER.  Registration is required.

More information about the Hospice PEPPER can be found at www.PEPPERResources.org.