CMS Incorporates Targeted Probe and Educate Guidelines into Medicare Program Integrity Manual

The Centers for Medicare & Medicaid Services (CMS) directed the Medicare Administrative Contractors (MACs) to replace the existing Progressive Corrective Action (PCA) medical review process with Targeted Probe and Educate (TPE) beginning October 1, 2017.  Under TPE, MACs conduct data analysis to identify appropriate areas for review and then identify providers with high claim denial…