Coming in July, PEPPER reports (Program for Evaluating Payment Patterns Electronic Report) will be made available for home health agencies. Already available for nursing homes, hospitals and other inpatient providers, agencies will now be able to review their potential for scrutiny.
PEPPER reports are free reports that summarize Medicare claim data in areas that are prone to fraud. Using these reports will allow your agency to stay one step ahead, by ensuring your billing and compliance practices do as much as possible to reduce the risk of fraudulent activity.
While most of the data is sanitized, identifying specific cases for outlier data is beholden on the agency. PEPPER reports will only list claims and data for Medicare fee-for-service claims and Medicare Secondary Payer claims that are greater than zero. Additional criteria will also be included such as high therapy cases, non-LUPA payments, and episodes with 5 or 6 visits; just outside of the LUPA threshold. (A LUPA is a ‘low utilization payment adjustment’ for an episode that has less than 5 visits.)
More information will be forthcoming as the initial data release is announced. To subscribe to more updates and review additional information, we recommend visiting www.pepperresources.org/.