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On November 28, 2018, CMS rescinded and replaced Transmittal 1919 with 2207 to clarify language that more accurately instructs MACs on subsequent rounds of the Targeted Probe and Education (TPE) initiative.

Specifically, CMS advised MACs that the new review probe (Rounds 2 and 3) must be for services/items furnished 45 days after the one-on-one (1:1) education, and not just the submission date of the claim (except for long services related to home health and hospice).

Per CMS, MACs shall implement edits for Round 2 and Round 3, using only those items, services, and/or devices with the date of service/date that the item is furnished occurring after the previous 1:1 education intervention, allowing 45 - 56 days between each education intervention and the next round for the provider/supplier to improve.

This change comes as a direct result of providers and suppliers communicating with CMS that the claims chosen for subsequent TPE audits were being selected based on submission dates and were not date of service driven. Therefore, not allowing ample time for the supplier to make the appropriate process changes resulting from errors identified in earlier rounds.

This instruction applies to any new Round 2/Round 3 edits put in place after the issuance of this change request.

Click here to reveiw the change request (CR10249). You will need to open the file from the downloads section to view.

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