Tag: Targeted Probe and Educate

WASHINGTON – The Jurisdiction D DME MAC Medicare Review Department is conducting Targeted Probe and Education (TPE) pre-payment supplier specific reviews for 10 specialties, Noridian Healthcare Services has announced. Those specialties are ankle-foot orthotics, glucose testing supplies, knee orthosis, manual wheelchairs, ostomy supplies, pneumatic compression devices, therapeutic shoes, spinal orthotics, surgical dressings and urological supplies. The current error rates for TPE pre-payment...

WASHINGTON - CMS has updated its “Targeted Probe and Educate” program in two ways that could potentially make it easier and more fair for HME providers.The agency on Dec. 31 implemented the “TPE 10-Claim Preview Pilot” to allow the MACs to select just 10 claims for review under Round 1. If a provider is found to be compliant, the NPI associated with those claims will be exempt from reviews for about one year for those services/items.“In some ways it's good,” said...

As you are likely well aware by now, Medicare has transitioned away from widespread prepayment review and is now full speed ahead on their Targeted Probe and Educate (TPE) audit program. The key word here being “targeted.” The widespread medical review audits were previously focused on procedure codes and not necessarily on providers. Anyone submitting claims for codes under review were subject to prepayment audits. Now, they pick specific suppliers to focus their audit efforts on based...

WASHINGTON - Enteral nutrition had the highest error rate (87%) from Targeted Probe and Educate audits in Jurisdiction D.Noridian Healthcare Services, the DME MAC for Jurisdiction D, posted the error rates from TPE audits (see below) from Oct. 1 to Dec. 31, 2017.AAHomecare has requested that all the DME MACs publish the error rates.The error rates in Jurisdiction D are:19%, ankle-foot/knee-ankle-foot orthosis (L4360, L4362, L4386, L4387)87%, enteral nutrition (B4150, B4152, B4154)35%, external infusion...

MODESTO, Calif. - Home Oxygen Company has cleared the first round of review for the Targeted Probe and Educate program, the company announced April 25. “This is a collaborative effort between internal and external teams, resulting in compliant files,” said Andrea Ewert, CEO. “We continue our process for success despite the obvious burden.” Noridian Healthcare Solutions, the DME MAC for jurisdictions A and D, selected Home Oxygen Company's CPAP claims for the TPE program...

WASHINGTON - CMS will expand its Targeted Probe and Educate program to include all of the Medicare Administrative Contractors effective Oct. 1. Under the program, the MACs will identify providers with the highest claim error rates or billing practices that differ significantly from their peers and offer individualized education. The program began as a pilot project in one MAC jurisdiction in June 2016 and expanded to three additional jurisdictions in July 2017. CMS announced in August that it would...