CMS Updates Targeted Probe & Educate Information

The Centers for Medicare & Medicaid Services (CMS) published updated targeted probe and educate (TPE) information contained in Chapter 3 of the CMS Program Integrity Manual (Publication 100-08) through Transmittal 10132/Change Request (CR) 11695. The updates incorporate information about TPE practices providers have experienced, but were not clearly outlined in the Manual. This update includes…

CMS Issues New Waivers under the Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) has waived some significant provisions of the home health Conditions of Participation. The following items under the CoP have been waived by CMS. The initial evaluation under 484.55 (a) will not require an on-site visit and may be conducted remotely or through medical review. This does not…

CMS Holds Hospice, Home Health “Patients over Paperwork” Listening Sessions at NAHC Conference

–Sessions part of CMS’ expansion of “customer engagement” initiatives Approximately one year ago the Centers for Medicare & Medicaid Services (CMS) announced its “Patients over Paperwork” initiative, under which the agency began in-depth discussions on steps that could be taken to reduce unnecessary regulatory burdens on health care providers, increase efficiencies, and improve the beneficiary…

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…

Preparing for Hospice Targeted Probe and Educate (TPE)

Special thanks to Katie Wehri, CHPC, Healthcare Provider Solutions, Inc., (HPS) for writing today’s story on “Preparing for Hospice Targeted Probe and Educate (TPE)” and to HPS for use of their General Inpatient Level of Care and Medicare Hospice Election Forum audit tools. As previously reported, effective October 1, 2017, the Centers for Medicare &…

Your Questions about CMS’ Targeted Probe and Educate – Answered!

The Centers for Medicare & Medicaid Services (CMS) utilizes Medicare Administrative Contractors (MAC) to review clinical documentation in order to prevent improper payments. MACs choose claims for review based on many factors such as the service specific improper payment rate, data analysis and billing patterns of the provider. In 2014 CMS began a program that…