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In the most recent issue of the CMS MLN Connects Newsletter, CMS announced that they are restarting the Targeted Probe and Educate (TPE) program.

The program, which was established with a goal to “help educate providers and reduce future denials and appeals”, includes up to three rounds of supplier-specific prepayment probe reviews conducted by the MAC medical review department. Following each round, education is provided to the supplier, based on review results, in an effort to improve identified errors. If a high error rate persists following the maximum rounds of review and education, MACs may refer the supplier to CMS for possible further action.

What can suppliers expect?

If the MAC identifies your organization for TPE, you will receive a written notification from the DME MAC that will include (1) the topic being reviewed, (2) data reasons for the selection and (3) the process of the review. The first-round prepayment probe review will begin following notification to the supplier.

If a high error rate is determined upon completion of the prepayment probe review, the DME MAC will offer one-on-one education relative to the specific errors identified. Following education, suppliers are expected to make necessary corrective actions and demonstrate significant improvement during the  subsequent round probe review. Once a supplier has reached an acceptable error rate, the TPE process will end and the supplier will be notified of successful completion.

Want to be ‘audit-ready’? The van Halem Group can help!

Our team of experts have solutions to ensure your claims are audit ready and meet technical and clinical guidelines. We offer clinical prescreens of your claims prior to submission, can review your TPE files prior to responding to the ADR request, assist in development of corrective action (CAP) and process improvement (PIP) plans, and even provide support and representation throughout your TPE audit period.

Contact us to learn more about our TPE Audit Response services.