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Hospice alert: new release of PEPPER coming in April

Theresa M. Forster, Vice President for Hospice Policy & Programs at NAHC, has shared an update about hospice PEPPER reports that we wanted to share with our hospice software customers and friends

Hospices will soon receive the 2nd release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER). PEPPER will be distributed to hospices in hard copy via FedEx addressed to the CEO in April 2013. The PEPPER is a free report, which is provided by CMS and includes hospice-specific data statistics for services that may be at risk for improper Medicare payments. Hospices can use the data to support internal auditing and monitoring activities. PEPPER compares a hospice’s Medicare billing practices with other hospices in the state, MAC and nation. CMS has contracted with TMF Health Quality Institute to develop and distribute the reports.


Note the following changes in the PEPPER:

1. This release (version Q4FY12) summarizes the three most recent federal fiscal years of hospice claims data (fiscal years 2010, 2011 and 2012). The federal fiscal year runs from October 1 through September 30. The first release (version RY2011) summarized three hospice cap rate years (the cap year runs November 1 through October 31).

2. TMF has made changes in the way hospice claims are evaluated for the reports. The first release reported on all services provided during each reporting year. This release reports on beneficiaries whose episode of service ends in the reporting year, whether by death or by live discharge. Because of these changes:

  • The “Live Discharges” target area counts include all episodes (instead of the most recent episode) where the beneficiary was discharged alive with a length of stay less than 25 days.
  • The “Long Length of Stay” target area counts beneficiary episodes of service that had a long length of stay (greater than 180 days) only in the time period in which the beneficiary was discharged or died (instead of in each time period during which they received greater than 180 days of service, regardless of whether they were discharged or died).

3. The definition of the “Live Discharges” target area was updated in compliance with CMS Transmittal 2410 Change Request 7677 for all episodes of service that end on or after July 1, 2012.

Please refer to the Hospice PEPPER Users Guide for details regarding how episodes of service are constructed and for the updated definition of the Live Discharges target area. For more information, including training materials and a demonstration Hospice PEPPER, visit PEPPERresources.org. Hospice staff are encouraged to join the e-mail list on this website to receive information about the upcoming PEPPER distribution and training opportunities. Questions regarding PEPPER may be submitted through the Help Desk.

We also welcome you to watch the 10-minute hospice PEPPER webinar to learn more.

elderly senior patient with nurse caregiver holding hands

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