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BE ATTENTIVE: MEDICARE TARGETED PROBE AND EDUCATE PROGRAM
Regulatory Updates

CMS's Targeted Probe and Educate (TPE) program is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.  Not every provider will need TPE. If you were chosen for the program, you will receive a letter and then the MAC will inspect 20-40 claims and supporting medical documentation. In case some claims are denied you will get an invitation to an education session. 

Targets to identify: 

  • providers and suppliers who have high claim error rates or unusual billing practices, and
  • items and services that have high national error rates and are a financial risk to Medicare. 

Any problems that fail to improve after 3 rounds of education sessions will be subject for next steps. These steps could be 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action.

Insights
May 2018