Courtesy of the National Association for Home Care & Hospice

The Home Health Program for Evaluating Payment Patterns Electronic Report (PEPPER) is available for download at the PEPPER portal. PEPPER summarizes Medicare claims data statistics for a provider in “target areas” that may be at risk for improper Medicare payments and compares the provider’s Medicare claims data statistics with aggregate Medicare data for the nation, Medicare Administrative Contractor (MAC) jurisdiction, and the state.

While the PEPPER cannot identify improper payments, it does help a provider to identify areas, where its performance falls outside the norm and payments, may be at risk.

There are three new target areas for home health this year and the High Therapy Utilization Episodes target area was deleted. Also, the Top Diagnoses Report and Top Therapy Episodes Report were deleted and a Top Clinical Groups Report was added. These changes were made to align the target areas and reports with the new risks associated with the Patient-Driven Groupings Model (PDGM).

This year’s target areas are outlined below.