Beginning in July, agencies will have access to a free tool from quality improvement organization TMF Health Quality Institute that will help them address their risks for overpayment from Medicare, according to a report on the TMF website.
 
The tool, known as the Program for Evaluating Payment Patterns Electronic Report (PEPPER), and which is already available for hospices, short- and long-term acute care hospitals and other providers, essentially consists of reports on billing rates in risk areas. These areas include: Outlier payments, average number of episodes per beneficiary, average case-mix, episodes with five or six visits, non-LUPA payments and high therapy utilization payments.
 
The reports will allow agencies to compare their billing rates to those of their peers nationwide, in Medicare administrative contractor jurisdictions and in states in target areas, TMF says.
 
For instance, a red flag to an agency looking at the reports would be when a provider’s billing in a target area, like an outlier payment, is at or above the national 80th percentile, which means it bills at a higher percentage in outlier payments than 80% of providers do nationally, TMF says. Such a finding doesn’t necessarily mean an error occurred, but providers should make sure there is a reasonable explanation.
 
Related links: Home health agencies can go to the PEPPER Resources Portal to sign up to receive the reports at: https://securefile.tmf.org. Find more information and PEPPER resources here: http://www.pepperresources.org/Training-Resources/Home-Health-Agencies.