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 2019, 2020 and 2021. 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 2021 (January 1-December 31, 2021). 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, 7th 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 2021 (January 1-December 31, 2021). 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).