At Nicholson & Eastin, LLP, we recognize the importance of staying up-to-date with the evolving healthcare regulations, including initiatives like the Targeted Probe & Educate (TPE) program introduced by the Centers for Medicare and Medicaid Services (CMS).
The Centers for Medicare and Medicaid Services have replaced the Progressive Correction Action or PCA with Targeted Probe & Educate or TPE. The TPE program aims to assist healthcare providers in reducing claim denials and improving compliance through personalized one-on-one assistance.
Targeted Probe & Educate (TPE) is a program established by the Centers for Medicare and Medicaid Services (CMS) to assist healthcare providers in improving their claim submission practices and reducing claim denials. Under this program, Medicare Administrative Contractors (MACs) conduct targeted reviews of medical claims and supporting records for selected providers. The goal of TPE is to identify potential compliance issues and errors in claims, and then provide one-on-one education and support to help providers address and rectify these issues. The program aims to enhance providers’ understanding of Medicare guidelines and policies, ensuring accurate reimbursement and promoting efficient and compliant billing practices.
The goal of TPE is to help providers improve as quickly as possible. Medicare Administrative Contractors or MACs will work with them, in person to pinpoint errors and support in correcting them. Some of the most common errors that can be easily corrected include:
The Targeted Probe & Educate (TPE) Program targets healthcare providers and medical suppliers who have a higher likelihood of claim errors based on data analysis. Medicare Administrative Contractors (MACs) focus on providers and suppliers that exhibit the following characteristics:
It’s important to note that the TPE Program aims to help providers improve their compliance and billing practices rather than solely reprimanding non-compliance. The selection process is data-driven and seeks to identify areas where providers can enhance their claims submission process to reduce errors and ensure accurate billing practices.
The Targeted Probe & Educate (TPE) Program offers several benefits for healthcare providers and medical suppliers:
Overall, the TPE Program facilitates a collaborative approach between Medicare Administrative Contractors (MACs) and providers, fostering continuous improvement and ensuring the integrity of the Medicare program.
If a provider is chosen for TPE, they will receive a letter from the MAC. The MAC will review 20 to 40 of the provider’s medical claims and supporting medical records. In the event a provider is compliant, they will not be reviewed again for at least a year on the selected topic.
If there is a denial of some claims, the provider will be invited to a one-on-one education session. The one-on-one education session will likely be held via webinar or teleconference and walk through any errors in the 20 to 40 of the provider’s reviewed claims. Providers will also receive the chance to ask questions regarding their claims and CMS policies that apply to the services or items that were reviewed.
After the one-on-one education session, they will be granted a 45-day period to make changes and improve. After the 45-day period, the MAC will again review 20 to 40 medical claims and supporting medical records, and the process repeats.
Fortunately, the majority of providers that have participated in the TPE process have successfully increased their claim accuracy. However, if providers fail to improve after three education sessions, they will be referred to CMS for next steps, which may be 100 percent prepay review, extrapolation, or a referral to a Recovery Auditor.
It is important for healthcare professionals to treat TPE as seriously as they would treat any other governmental audit. The attorneys at Nicholson & Eastin, LLP encourage providers who receive TPE notification letters to reach out right away. We can help guide providers with responding and without disrupting the productivity and workflow of their practice. Contact us, today.