Call us today: 718-934-6714 EX 1202 3047 Avenue U, Brooklyn New York 11229
TARGETED
PROBE AND
EDUCATE
Doctor For Doctor
QUESTIONS AND ANSWERS
Question:

What is Targeted Probe and Educate?

Answer:

When performing medical review as part of Targeted Probe and Educate (TPE), Medicare Administrative Contractors (MACs) focus on specific providers/suppliers that bill a particular item or service rather than all providers/suppliers billing a particular item or service. MACs will focus only on providers/suppliers who have the highest claim denial rates or who have billing practices that vary significantly from their peers. TPE involves the review of 20-40 claims per provider/supplier, per item or service. This is considered a round, and the provider/supplier has a total of up to three rounds of review. After each round, providers/suppliers are offered individualized education based on the results of their reviews. Providers/suppliers are also offered individualized education during a round to more efficiently fix simple problems.

Doctor For Doctor
Question:

What should a provider/supplier expect during a 1-on-1 education session?

Answer:

During a one 1-on-1 education session (usually held via teleconference or webinar), the MAC provider outreach and education staff will walk through any errors in the provider/supplier’s 20-40 reviewed claims. Providers/suppliers will have the opportunity to ask questions regarding their claims and the CMS policies that apply to the item/service that was reviewed.

Question:

Can a provider/supplier be included in multiple TPE probes at the same time?

Answer:

Yes, if a provider/supplier has multiple National Provider Identifiers (NPIs), each NPI could be subject to TPE review. Additionally, if a provider/supplier submits claims to Medicare for more than one item or service, each item/service could be subject to a separate probe as part of the TPE program. Providers/Suppliers and the specific items and services included in the TPE process are those who have been identified through data analysis as being a potential risk to the Medicare trust fund and/or who vary significantly from their peers.

Read here the full list of questions and answers.

Issues schedule

Subscribe now!

Get all news delivered to your email monthly. Select one of the following options:

ONE YEAR SUBSCRIPTION for $83.88
6 MONTH SUBSCRIPTION for $41.94
WCH Service Bureau will charge credit card account for the Newsletter. For using any of the credit cards and PayPal option, convenience fee will be charged at a rate of 3%.
Insights
December 2018