TMF Health Quality Institute, under contract with CMS, compiles data about claim trends called the Program for Evaluating Payment Patterns Electronic Report (PEPPER). A CEO, President, Administrator or Compliance Officer of your organization can browse to the PEPPER Resources Portal with your home health agency’s basic demographics, CMS certification number (or PTAN) and a Validation Code (a patient control number or medical record number that was referenced on a claim in a specified time period – now 4th Quarter 2016). The report gives comparisons of your agency’s

  • average case mix,
  • average number of episodes per client,
  • non-LUPA episodes, and
  • high therapy utilization episodes

against the National, Jurisdiction and State percentiles to help agencies identify any potential service issues.

It also evaluates

  • episodes with 5 or 6 visits,
  • outlier episodes,
  • top diagnoses, and
  • top therapy diagnoses.

Agencies that score at or above the 80th percentile in any statistic should investigate those related claims and make sure that they are clinically justified. This can be an extremely helpful resource in developing your Quality Assurance Performance Improvement (QAPI) program. Something to think about with the new Conditions of Participation (CoPs) starting January 1, 2018.

To learn more about this report, go to the PEPPER Resources website and look for your facility type (Home Health Agencies) for more information.