Program for Evaluating Payment
Patterns Electronic Report

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Training & Resources for Hospice

PEPPER Resources

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Current PEPPER User's Guide:

Jurisdictions:

  • View a list of the 4 MAC jurisdictions and the number of hospices in each jurisdiction in total and by state for PEPPER version Q4FY13 (15 KB XLS).
  • View a list of the 4 MAC jurisdictions and the number of hospices in each jurisdiction in total and by state for PEPPER version Q4FY12 (36 KB XLS).
  • View a list of the 4 MAC jurisdictions and the number of hospices in each jurisdiction in total and by state for PEPPER version RY2011 (26 KB XLS).

Hospice PEPPER Training Update - March 2013

PEPPER Training (September 13, 2012):

What is PEPPER?

The Hospice PEPPER is a report that summarizes a hospice’s Medicare claims data in areas that may be at risk for abuse or improper payment. PEPPER compares a hospice’s claims data statistics with aggregate statistics for other hospices in the state, MAC/FI jurisdiction and the nation. Hospices with high billing patterns (at or above the national 80th percentile) are identified as at risk for improper Medicare payments and are encouraged to ensure that they are complying with Medicare payment policy, that services provided to beneficiaries are medically necessary and that medical record documentation supports the services that are billed.

PEPPER cannot identify the presence of improper payments. Only a review of the medical record can determine whether services are medically necessary and appropriately billed.

Distribution Schedule

TMF will distribute PEPPER according to this schedule and methods.

Demonstration PEPPER:

  • Demonstration PEPPER version Q4FY13 (289 KB XLS, updated 3/19/2014)

Other Resources:

  • View the list of Hospice PEPPER target areas (19 KB Word, updated 3/19/2014).
  • View this slide presentation (PPT file, updated 7-11-2013) on percents and percentiles to help understand the differences between “percent” and “percentile” and how they are used in PEPPER.
Sample PEPPER
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Curious as to how the Hospice PEPPER looks? View a hospice demonstration Q4FY12 PEPPER (1 MB XLS).

Read this article for an overview of changes in the Q4FY12 Hospice PEPPER. For more details, view the updated training session.