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.┬á Under TPE, MACs conduct data analysis to identify appropriate areas for review and then identify providers with high claim denial…