Home Health Providers Seek Clarity on CMS Plan to Resume TPE Program

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.

You can reach us at 1-866-263-3795 or by completing the contact form.

Click here for the full article.

About Corridor

For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.

Focusing on key operational, regulatory and financial challenges, Corridor delivers solutions and deep expertise in coding, clinical documentation, compliance, billing and education.

To receive the most important industry updates, insights and news impacting home health and hospice, please make sure to sign up for our weekly newsletter.

Explore Corridor’s Solutions

Share This Story, Choose Your Platform!