Posted Sunday, September 19, 2021
In response to COVID, CMS pressed pause on the targeted probe and educate (TPE) program in March 2020. A year later, CMS has plans to resume the program.
TPE is a medical review that began for the home health and hospice in December 2017. The goal of the program is to weed out improper payments by focusing on providers with high claims denial rates or unusual billing practices.
If providers are selected for a TPE audit, MAC reviews between 20 to 40 of their claims and supporting medical records.
“They’re going to be looking for things that may indicate if the provider has claims that are possibly representing errant billing to CMS because you can’t substantiate the need for the service,” Cindy Campbell, director of operational consulting at WellSky, told Home Health Care News.
If you have had many denials, CMS may be looking to ensure your agency’s billing is equitable. Corridor can help you verify each claim is valid and supported by clinical documentation.
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