Tag: TP&E

CMS to Proceeed with Targeted Probe and Educate

The Centers for Medicare & Medicaid Services (CMS) has decided to continue to proceed with the Targeted Probe and Educate (TPE) medical review, which they resumed on September 1, 2021. (Please see NAHC Report CMS Resumes Targeted Probe & Educate.) Although, the Medicare Administrative Contractors (MACs) have been conducting limited medical review since August 2020, a…

CMS Resumes Targeted Probe & Educate

NAHC urges CMS to suspend TPE until the public health emergency ends The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that it will resume the targeted probe and educate (TPE) program that was suspended in March 2020 (as were most medical reviews) due to the COVID-19 public health…

Medical Review Resumes This Month

The Centers for Medicare & Medicaid Services (CMS) will resume medical revnew this month after originally delaying the program during the COVID-19 public health emergency (PHE). (NAHC Report originally reported this news on July 9.) On March 30, CMS suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic and, seemingly, for the…

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…

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 &…