Home Health & Hospice Week

Here’s why you didn’t see these key states in Palmetto’s TPE results.

Where are some of the biggest Medicare states in Targeted Probe & Educate review? One MAC tells Eli.

If you looked closely at the Targeted Probe and Educate results recently released by HHH Medicare Administrative Contractor Palmetto GBA, you may have noticed some major states missing — Illinois and Florida, in particular.

Eli went straight to the source to find out why — and if the Pre-Claim Review demonstration had anything to do with it. “Palmetto GBA’s decisions on providers selected for Targeted Probe and Educate (TPE) were not driven by Pre-Claim Review (PCR) or Review Choice Demonstration (RCD),” a MAC representative says in an emailed response.

So what does affect providers’ inclusion in TPE? “Palmetto GBA selected states based on the volume of providers who were outliers in multiple states,” the rep explains. “Florida is scheduled for selection for Targeted Probe and Educate (TPE) later in the calendar year or first portion of 2019, depending on the implementation schedule for RCD as determined by the Centers for Medicare & Medicaid Services.”

But once the RC demo is in place, TPE is off the table. “Once RCD is implemented in a state, Palmetto GBA will not conduct Medical Review activities for Home Health services in a state participating in RCD,” the contractor confirms.

At press time, the Office of Management and Budget still had not granted approval for RCD and the program had not launched in Illinois. CMS’s target date to begin RCD in that state was Dec. 10.