Navigating the Process: Target, Probe, and Educate (TPE)

Описание: The Targeted Probe and Educate strategy was implemented on October 1, 2017. After conducting successful probe and educate projects related to short inpatient hospital stays and home health services, CMS expanded this approach to all MAC reviews.

It is the goal of CMS to create opportunities for increased one to one provider education resulting in decreased denials.

There have been no changes to Medicare policies or the review process, which involves a request for additional documentation, submission of the documentation within the 45 day timeframe, and review of the documentation.

What has changed is that widespread edits will no longer be conducted, which involved review of claims for all providers submitting claims meeting certain parameters. MACs will only review those providers that are identified through data analysis as outliers. We will discuss further what defines an outlier.