The link below provides national-level statistics for areas identified as at-risk for improper payments in critical access hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in the nation. For more information on the areas identified as at risk for improper payments, please see the Critical Access Hospital PEPPER User’s guide (PDF, 9th Edition).

A listing of the top 20 DRGs by volume of Medicare discharges for all critical access hospitals in the nation. The data are aggregated at the national level. The data include the number of discharges, proportion of discharges for the DRG to total discharges and national average length of stay for each DRG. The data represent the most recent four quarters of discharges.

The link below provides state-level statistics for areas identified as at-risk for improper payments in critical access hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in each state with three or more CAHs. This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state. Target area statistics are reported when there are at least three hospitals with 11+ target area discharges. For more information on the areas identified as at risk for improper payments, please see the Critical Access Hospital PEPPER User’s guide (PDF, 9th Edition).

A listing of the top DRGs (up to 20) by volume of Medicare discharges for all critical access hospitals in each state with three or more CAHs. The data are aggregated at the state level. The data include the number of discharges, proportion of discharges for the DRG to total discharges and average length of stay for each DRG. The data represent the most recent four quarters of discharges. This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state. DRGs are included in the report if there are at least 11 discharges for the DRG in the most recent four quarters.

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for critical access hospitals in three categories: total number of discharges, location and ownership type. The statistics were calculated for CAH discharges ending in fiscal year 2019 (October 1, 2018-September 30, 2019). For details on how these charts were developed please see the CAH Peer Group Methodology (PDF, updated 5/2/19). For a listing of all CAHs and their peer group classification please see the CAHs by peer group file (XLSX, updated 07-27-2020). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.

Provides national-level statistics for areas identified as at-risk for improper payments in home health agencies for the most recent three calendar years. The data include, for each target area, the numerator and denominator counts, proportion/rate, average length of stay (where calculated) and the average and total Medicare payment (where calculated) for all HHAs in the nation. For more information on the areas identified as at risk for improper payments, please see the HHA PEPPER User’s guide. Home Health PEPPER User’s Guide (PDF, 4th Edition).

Provides a listing of the top 20 clinical classification software (CCS) diagnoses by volume of episodes for all HHAs in the nation for the most recent calendar year. The data are aggregated at the national level and include the number of episodes per CCS category, proportion of episodes for each CCS to total episodes and the number of visits and average number of visits for each CCS category. For more information on the top 20 diagnoses report, please see the Home Health PEPPER User’s Guide (PDF, 4th Edition).

Provides the top CCS diagnosis categories (up to five) for five groups of episodes: Early 0-13 therapy visits episodes, Early 14-19 therapy visits episodes, Late 0-13 therapy visits episodes, Late 14-19 therapy visits episodes and All 20+ therapy visits episodes for all HHAs in the nation for the most recent calendar year. For each therapy group the report includes the number of episodes, the proportion of all episodes, the total number of therapy visits and the average number of therapy visits for all HHAs in the nation for the most recent calendar year. The top diagnosis categories (up to five) for each therapy group are listed, along with the number of episodes for the diagnosis category, the proportion of episodes for the diagnosis category within each therapy group, the number of therapy visits and the average number of therapy visits.

Provides state-level statistics for areas identified as at-risk for improper payments in home health agencies for the most recent three calendar years for each state/territory. The data include, for each target area, the numerator and denominator counts, proportion/rate, average length of stay (where calculated) and the average and total Medicare payment (where calculated) for all HHAs in the state/territory. For more information on the areas identified as at risk for improper payments, please see the Home Health PEPPER User’s Guide (PDF, 4th Edition).

Provides a listing of the top 20 clinical classification software (CCS) diagnoses by volume of episodes for all HHAs in each state/territory for the most recent calendar year. The data are aggregated at the state/territory level and include the number of episodes per CCS category, proportion of episodes for each CCS to total episodes and the number of visits and average number of visits for each CCS category. For more information on the top 20 diagnoses report, please see the Home Health PEPPER User’s Guide (PDF, 4th Edition).

Provides the top CCS diagnosis categories (up to five) for five groups of episodes: Early 0-13 therapy visits episodes, Early 14-19 therapy visits episodes, Late 0-13 therapy visits episodes, Late 14-19 therapy visits episodes and All 20+ therapy visits episodes for all HHAs in each state/territory for the most recent calendar year. For each therapy group the report includes the number of episodes, the proportion of all episodes, the total number of therapy visits and the average number of therapy visits for all HHAs in the state/territory for the most recent calendar year. The top diagnosis categories (up to five) for each therapy group are listed, along with the number of episodes for the diagnosis category, the proportion of episodes for the diagnosis category within each therapy group, the number of therapy visits and the average number of therapy visits.

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for home health agencies in three categories: total number of episodes, location and ownership type. The statistics were calculated for HHA episodes ending in calendar year 2018 (January 1-December 31, 2018). For details on how these charts were developed please see the HHA Peer Group Methodology document (PDF). For a listing of all HHAs and their peer group classification please see the HHAs by peer group file (XLSX). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.

Provides national-level statistics for areas identified as at risk for improper Medicare payments in hospices. The data include the number of Medicare beneficiary episodes of service/days for the numerator and denominator for each target area, proportion for each target area, average length of stay for the numerator episodes of service/days (where applicable) and the average Medicare payment and the sum of total Medicare payments (where applicable) for the numerator episodes of service/days for each target area for all hospices in the nation for fiscal years 2017, 2018 and 2019. For more information on the areas identified as at risk for improper payments, please see the Hospice PEPPER User’s Guide (PDF, 9th Edition).

A listing of the top terminal clinical classification system (CCS) diagnosis categories by total number of Medicare decedents for all hospices in the nation. The data are aggregated at the national level. The data include the number of decedents, proportion of decedents for the terminal CCS diagnosis category to total decedents and the national average length of stay for each terminal diagnosis category. The data represent fiscal year 2019 (October 1, 2018 – September 30, 2019). For more information on the terminal diagnoses, please see the Hospice PEPPER User’s Guide (PDF, 9th Edition).

Provides national-level statistics for beneficiaries discharged from hospice care alive. The data include, for each live discharge category, the number of Medicare beneficiary episodes, the proportion of all live discharges and the average length of stay for the most recent three fiscal years (2017, 2018 and 2019). The overall live discharge rate is also presented. For more information on the types of live discharges, please see the Hospice PEPPER User’s Guide (PDF, 9th Edition).

Provides statistics for areas identified as at risk for improper Medicare payments for hospices in each state/territory. The data include the number of Medicare beneficiary episodes of service/days for the numerator and denominator for each target area, proportion for each target area, average length of stay for the numerator episodes of service/days (where applicable) and the average Medicare payment and the sum of total Medicare payments for the numerator episodes of service/days (where applicable) for each target area for all hospices in each state/territory for fiscal years 2017, 2018 and 2019. For more information on the areas identified as at risk for improper payments, please see the Hospice PEPPER User’s Guide (PDF, 9th Edition).

A listing of the top terminal clinical classification system (CCS) diagnosis categories by total number of Medicare decedents for each state/territory. The data are aggregated at the state level. The data include the number of decedents, proportion of decedents for the terminal CCS diagnosis category to total decedents and the state average length of stay for each terminal diagnosis category. The data represent fiscal year 2019 (October 1, 2018 – September 30, 2019). For more information on the terminal diagnoses, please see the Hospice PEPPER User’s Guide (PDF, 9th Edition).

Provides state-level statistics for beneficiaries discharged from hospice care alive. The data include, for each live discharge category, the number of Medicare beneficiary episodes, the proportion of all live discharges and the average length of stay for the most recent three fiscal years (2017, 2018 and 2019) for each state. The overall state live discharge rate is also presented. For more information on the types of live discharges, please see the Hospice PEPPER User’s Guide (PDF, 9th Edition).

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for hospices in three categories: total number of episodes, location and ownership type. The statistics were calculated for hospice episodes ending in fiscal year 2019 (October 1, 2018 – September 30, 2019). For details on how these charts were developed please see the Hospice Peer Group Methodology document (PDF, updated 5/2/19). For a listing of all hospices and their peer group classification please see the hospices by peer group file (XLSX, updated 07-27-2020). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.

Provides national-level statistics for areas identified as potentially at risk for improper payments in IPFs for 1) all IPFs in the nation, 2) all IPF distinct part units of short-term acute care or critical access hospitals in the nation, and 3) all free-standing IPFs in the nation. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area (excluding the “Outlier Payments” target area, for which the average outlier payment is calculated) and the sum of total Medicare payments for each target area for the most recent three fiscal years. For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide (PDF, 9th Edition).

A listing of the top 20 DRGs by volume of Medicare discharges for 1) all IPFs in the nation, 2) all free-standing IPFs in the nation, and 3) all IPF distinct part units of short-term acute care or critical access hospitals in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the DRG to total discharges and national average length of stay for each DRG. The national standard deviation of the length of stay for each DRG is also included. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

The link above provides state-level statistics for areas identified as potentially at risk for improper payments in IPFs. The data represent the most recent three fiscal years and include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area (excluding the “Outlier Payments” target area, for which the average outlier payment is calculated) and the sum of total Medicare payments for each target area for all IPFs in each state with three or more IPFs. For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide (PDF, 9th Edition).

A listing of the top 20 DRGs by volume of Medicare discharges for all IPFs in each state with three or more IPFs. The data are aggregated at the state level and include the number of discharges, proportion of discharges for the DRG to total discharges and state average length of stay for each DRG. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for free-standing IPFs and for IPF distinct part units of short-term acute care hospitals for the most recent four quarters ending Q4FY19 (October 1, 2018 – September 30, 2019). For more information on the areas identified as potentially at risk for improper payments, please see the IPF PEPPER User’s Guide (PDF, 9th Edition).

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for inpatient psychiatric facilities in three categories: total number of discharges, location and ownership type. The statistics were calculated for IPF discharges ending in fiscal year 2019 (October 1, 2018-September 30, 2019). For details on how these charts were developed please see the IPF Peer Group Methodology Document (PDF, updated 5/2/19). For a listing of all IPFs and their peer group classification please see the IPFs by peer group file (XLSX, updated 07-27-2020). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.

The link above provides national-level statistics for areas identified as potentially at risk for improper payments in IRFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area. The data are aggregated in three ways: 1) all IRFs in the nation, 2) all IRF distinct part units of short-term acute care or critical access hospitals in the nation, and 3) all free-standing IRFs in the nation. The data represent the most recent three fiscal years. For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide (PDF, 10th Edition).

Listings of the top 20 RICs by volume of Medicare discharges for 1) all IRFs in the nation, 2) all IRF distinct part units of short-term acute care or critical access hospitals in the nation, and 3) all free-standing IRFs in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the RIC to total discharges and national average length of stay for each RIC. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Listings of the top 20 CMGs by volume of Medicare discharges for 1) all IRFs in the nation, 2) all IRF distinct part units of short-term acute care or critical access hospitals in the nation, and 3) all free-standing IRFs in the nation. The data are aggregated at the national level and include the number of discharges, proportion of discharges for the CMG to total discharges and national average length of stay for each CMG. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Identifies the number of discharges, proportion of all discharges and average length of stay (ALOS) for each CMG tier level and for five discharge destinations for 1) all IRFs in the nation, 2) all IRF distinct part units of short-term acute care or critical access hospitals in the nation, and 3) all free-standing IRFs in the nation. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for free-standing IRFs and for IRF distinct part units of short-term acute care hospitals for the most recent four quarters ending Q4FY19 (October 1, 2018 – September 30, 2019). For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide (PDF, 10th Edition).

The link above provides state-level statistics for areas identified as potentially at risk for improper payments in IRFs. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all IRFs in each state with three or more IRFs. The data represent the most recent three fiscal years. For more information on the areas identified as potentially at risk for improper payments, please see the IRF PEPPER User’s Guide (PDF, 10th Edition).

Listings of the top 20 RICs by volume of Medicare discharges for all IRFs in each state with three or more IRFs. The data are aggregated at the state level and include the number of discharges, proportion of discharges for the RIC to total discharges and state average length of stay for each RIC. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Listings of the top 20 CMGs by volume of Medicare discharges for all IRFs in each state with three or more IRFs. The data are aggregated at the state level and include the number of discharges, proportion of discharges for the CMG to total discharges and state average length of stay for each CMG. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Identifies the number of discharges, proportion of all discharges and average length of stay (ALOS) for each CMG tier level and for five discharge destinations for all IRFs in each state with three or more IRFs. The data represent the most recent four quarters of discharges through Q4FY19 (October 1, 2018 – September 30, 2019).

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for inpatient rehabilitation facilities in three categories: total number of discharges, location and ownership type. The statistics were calculated for IRF discharges ending in fiscal year 2019 (October 1, 2018-September 30, 2019). For details on how these charts were developed please see the IRF Peer Group Methodology Document (PDF, updated 5/2/19). For a listing of all IRFs and their peer group classification please see the IRFs by peer group file (XLSX, updated 07-27-2020). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.

The link below provides national-level statistics for areas identified as at-risk for improper payments in long-term acute care hospitals. The data include the number of Medicare discharges for the numerator and denominator for each target area, proportion for each target area, average Medicare payment for a claim in each target area and the sum of total Medicare payments for each target area for all hospitals in the nation. For more information on the areas identified as at risk for improper payments, please see the Long-term PEPPER User’s Guide (PDF, 14th Edition).

A listing of the top 20 DRGs by volume of Medicare discharges for all long-term acute care PPS hospitals in the nation. The data are aggregated at the national level. The data include the number of Medicare discharges, average length of stay and number and percentage of discharges that are short-stay outliers for each DRG. The data represent the most recent four quarters of discharges.

The link above provides national-level statistics for areas identified as potentially at risk for improper payments in PHPs. The data include the numerator count and denominator count for each target area, proportion for each target area, numerator average length of stay and the average and sum of Medicare payments for each target area for 1) all PHPs in the nation, 2) all hospital-based PHPs in the nation and 3) all CMHC-based PHPs in the nation for calendar years 2016, 2017 and 2018. For more information on the areas identified as potentially at risk for improper payments and specifics on how the average length of stay and average and sum of payments are calculated, please see the PHP PEPPER User’s Guide (PDF, 7th Edition).

A listing of the top 10 Clinical Classification System (CCS) diagnoses by volume of episodes of care for 1) all PHPs in the nation, 2) all hospital-based PHPs in the nation and 3) all CMHC-based PHPs in the nation for calendar year 2018 (January 1-December 31, 2018). The data are aggregated at the national level and include the number of episodes of care, proportion of episodes of care for the diagnosis to total episodes of care and the national average length of stay for each diagnosis code. For more information on the top 10 diagnoses report, please see the PHP PEPPER User’s Guide (PDF, 8th Edition).

Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for CMHC-based PHPs and for hospital-based PHPs for calendar year 2018 (January 1-December 31, 2018). For more information on the areas identified as potentially at risk for improper payments, please see the PHP PEPPER User’s Guide (PDF, 7th Edition).

Provides national-level statistics for areas identified as potentially at risk for improper Medicare payments in SNFs. The data include the numerator and denominator counts for each target area (number of RUG days, assessments or episodes of care) for Medicare episodes of care ending in each time period (fiscal years 2017, 2018 and 2019), the proportion for each target area, average length of stay for the numerator (not applicable for the “Change of Therapy Assessment” target area), and average and sum of Medicare payment for the “90+ Day Episodes of Care” and “20-day Episodes of Care” target areas for all SNFs in the nation. For more information on the areas identified as potentially at risk for improper payments, please see the SNF PEPPER User’s Guide (PDF, 8th Edition).

A listing of the top 20 RUGs by Medicare days billed for all SNFs in the nation. The data are aggregated at the national level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of episodes of care with the RUG billed to total episodes of care, and the average number of days by RUG. The total number of and average length of stay for SNF episodes of care in the nation is identified in the header in the fourth and fifth rows. The data represent the episodes of care ending in the most recent four quarters through Q4FY19 (October 1, 2018 – September 30, 2019).

For episodes of care with 90+ days, lists the top 20 RUGs by Medicare days billed for all SNFs in the nation. The data are aggregated at the national level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of 90+ day episodes of care with the RUG billed to total 90+ day episodes of care, and the average number of days by RUG. The total number of SNF episodes of care with 90+ days in the nation is identified in the header in the fourth row. The data represent the episodes of care with 90+ days ending in the most recent four quarters through Q4FY19 (October 1, 2018 – September 30, 2019).

Graphs displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for free-standing SNFs and for SNFs that are a unit of a hospital for the most recent four quarters ending Q4FY19 (October 1, 2018 – September 30, 2019). For more information on the areas identified as potentially at risk for improper payments, please see the SNF PEPPER User’s Guide (PDF, 8th Edition).

Provides state-level statistics for areas identified as potentially at risk for improper Medicare payments in SNFs. The data include the numerator and denominator counts for each target area (number of RUG days, assessments or episodes of care) for Medicare episodes of care ending in each time period (fiscal years 2017, 2018 and 2019), the proportion for each target area, average length of stay for the numerator (not applicable for the “Change of Therapy Assessment” target area), and average and sum of Medicare payment for the “90+ Day Episodes of Care” and “20-day Episodes of Care” target areas for all SNFs in each state with three or more SNFs. The file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state. There are graphs in the workbook that compare the target area percents for all states and the nation for each target area. Target area statistics are reported when there are at least three SNFs with a numerator count of at least 11. For more information on the areas identified as potentially at risk for improper payments, please see the SNF PEPPER User’s Guide (PDF, 8th Edition).

A listing of the top RUGs (up to 20) by Medicare days billed for all SNFs in each state with three or more SNFs. The data are aggregated at the state level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of episodes of care with the RUG billed to total episodes of care, and the average length of stay for the RUG. The total number of SNF episodes of care in the state is identified in the header in the fourth row. The data represent the episodes of care ending in the most recent four quarters through Q4FY19 (October 1, 2018 – September 30, 2019). This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state.

For episodes of care with 90+ days, lists the top 20 RUGs by Medicare days billed for all SNFs in each state with three or more SNFs. The data are aggregated at the state level and include the number of Medicare RUG days billed, proportion of days billed to the RUG to total RUG days, the proportion of 90+ day episodes of care with the RUG billed to total 90+ day episodes of care, and the average length of stay for the RUG. The total number of SNF episodes of care with 90+ days in the state is identified in the header in the fourth row. The data represent the episodes of care with 90+ days ending in the most recent four quarters through Q4FY19 (October 1, 2018 – September 30, 2019). This file is a Microsoft Excel workbook; click on the worksheet tabs to obtain the report for each state.

Charts displaying, for each of the areas identified as potentially at risk for improper Medicare payments, the target area percents that are at the 80th, 50th and 20th percentiles for skilled nursing facilities in three categories: total number of episodes, location and ownership type. The statistics were calculated for SNF episodes ending in fiscal year 2019 (October 1, 2018 – September 30, 2019). For details on how these charts were developed please see the SNF Peer Group Methodology document (PDF, updated 5/2/19). For a listing of all SNFs and their peer group classification please see the SNF facilities by peer group file (XLSX, updated 07-27-2020). Note: use Control+F or the “Find” button to search the file for a CMS Certification Number (provider number) or provider name.