On December 31, CMS implemented the TPE 10-Claim Preview Pilot, which is intended to further reduce burden for compliant DME suppliers, according to AA Homecare.
The new 10-claim pilot allows for MACs to select 10 claims for TPE Round 1 for review. If the supplier is found to be compliant for the service/item, the NPI associated with the 10 claims will be exempt from reviews for roughly one year for the service/item. If errors are detected in the first round, suppliers will go through the usual TPE process.
Information for this pilot has yet to be published on the CMS or MAC websites. The van Halem Group will share more details as they become available.
This announcement comes on the heels of CMS updating MAC guidance for date of service driven Round 2 and Round 3 claim reviews. Ultimately, CMS seems to be working with suppliers to reduce audit burden.
If you have received a TPE audit request, don’t go through it alone! The van Halem Group has a team of experts available to assist you. We offer proactive and reactive services, designed to ensure you are in compliance with payor guidelines. Whether you need to be “audit ready” or have received an audit notification and need guidance throughout the process, we are here to help.
Our audit experts can conduct proactive claim audits and provide education to your staff, affording your organization the potential to identify risk areas before the auditors do. From a reactive perspective, we can review claims selected for audit, identify potential issues and develop a corrective action plan to present to the audit contractor. We will work hard to improve your processes and get you off the audit radar. For more information, contact us today!