All Set For This Year’s PEPPER?

July 17, 2019

Get set for compliance. Get set for competition. Get set for improvements. Get set for success. The third edition of PEPPER or the Program for Evaluating Payment Patterns Electronic Report is just around the corner. Is your agency ready to leverage all it has to offer?

PEPPER, sponsored by the CMS is a free educational tool that:

  • Analyzes HHAs claims data statistics for Medicare services that may be at risk for improper payments.
  • Supports an agency’s internal auditing and monitoring activities.
  • Provides HHAs with a statistical summary that pegs performance individually and as compared to national, state, and MAC jurisdiction results.

The report for HHAs summarizes data on the following areas:

  • Average case mix
  • Average number of episodes
  • Episodes with five or six visits
  • Non-LUPA payments
  • High therapy utilization episodes
  • Outlier payments

The report can support your agency’s compliance by helping self-monitor its billing practices and compare its activities with other HHAs nationwide to determine whether it is an outlier in its practices while identifying possible subjects of special review by the OIG.

The report can help identify areas of concern and even suggest ways your agency can respond. As well as reflects areas of improvement and success.

The state-wide and national benchmarks are accessible to the general public.
However only your agency’s CEO, President or Administrator can access information about your specific agency and your specific MAC jurisdiction. Not even MACs can access PEPPERs for agencies under their jurisdiction.

CMS continually analyzes claims data to guide Medicare payment reform, check if agencies are adhering to coverage rules, and to monitor industry trends. CMS  uses three years of Medicare claims data for agencies nationwide. This data goes into PEPPER. The reports are released every year at Expect the report for HHAs around July 17th. The HHA PEPPER with statistics through December 2015 has been available through the PEPPER Resources Portal since July 14, 2016. Each HHA PEPPER is available for two years from the original release date.

The HHA PEPPER can be accessed electronically via the PEPPER Resources Portal.

To access yours, the CEO, President, Administrator or Compliance Officer of your HHA should:

  • Review the Secure PEPPER Access Guide.
  • Visit the Distribution Schedule – Get Your PEPPER page at
  • Review instructions and obtain information required to authenticate access through PEPPER Resources
  • Access the PEPPER Resources Portal.
  • Complete all the fields.
  • Download your report.

So get ready for audit scrutiny. Get ready for improvements. This July, get access to your report and leverage it for success.

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