Expert says providers often wrongly threatened by PEPPER reports

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Instead of fearing further scrutiny by federal authorities, providers should embrace the opportunity to get feedback in the form of PEPPER reports, legal experts said Monday at the LeadingAge annual meeting and exposition in Nashville.

“Many don't know how to use or appreciate the various ways they can use PEPPER reports to enhance operations,” said Paula Sanders, a principal with the law firm Post & Schell. She noted the reports can increase staff communication regarding billing, facilitating best practices for compliance.

PEPPER stands for “Program for Evaluating Payment Patterns Electronic Report.” Its reports are intended to help providers assess their risk for improper Medicare payments and to guard against fraud, waste and abuse. They also help providers compare themselves to their peers.

The most recent PEPPER reports came out in May, but as of June, only 49% of providers had downloaded their results, said Sanders and her co-presenter, Stephanie Kessler, a partner at Reinsel Kuntz Lesher. "As an industry, post-acute care is woefully behind hospitals, for example, in how to look at and analyze our data," Sanders said.

“As cynical as I am, I love the PEPPER reports,” she added. “I really think of them as an education tool, a road map from the government — the only one they've ever given us.”

The experts also advised providers to engage legal representatives to review billing practices so that findings can be shielded by attorney-client privilege, should government officials subpoena records. Attorneys also should be consulted about creating “short retention policies” to quickly expunge internal emails about billing practices, they said.

Various therapy billing practices now get the most scrutiny. Kessler urged providers to keep a continual eye on contract therapy activities: “Look at therapy documentation, regardless of who's providing it.”In addition, providers should resist the urge to push extra minutes of therapy in order to reach a new payment level: Recent government data imply providers have often done so.

“If everything is recorded with a 0 or 5 at the end for therapy billing minutes, that is very bad,” Sanders explained. “The government is going to accuse you of rounding up. It could be somebody on light duty checking this. You should have a full flow of minutes.”

For more info and resources on PEPPER, click here.