Home Health & Hospice Week

You have 3 chances to get it right.

If you've ignored Targeted Probe & Educate details because you thought it applied only to home health agencies, now's the time to brush up on TPE basics. On its TPE webpage, the Centers for Medicare & Medicaid Services says the program:

• focuses on specific providers, selecting "claims for items/services that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate."
• reviews 20 to 40 claims per item or service, per round, for a total of up to three rounds.
• "After each round, providers are offered individualized education based on the results of their reviews," CMS says on its TPE website.
• MACs may "educate providers throughout the probe review process, when easily resolved errors are identified."
• After each round, the MAC has the opportunity to take you off TPE if you demonstrate "low error rates or sufficient improvement in error rates."
• "Providers/suppliers with continued high error rates after three rounds of TPE may be referred to CMS for additional action, which may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action," CMS says.