What Your Agency Needs to Know About Targeted Probe & Educate (From McBee Associates)

Last month, the Centers for Medicare & Medicaid Services (CMS) reported the Targeted Probe & Educate (TPE) program resumed after being suspended in March 2020 due to the COVID-19 public health emergency (PHE). Palmetto GBA and CGA released the TPE program resumed on September 1, 2021.

The National Association for Home Care & Hospice (NAHC) is advocating CMS to continue the TPE suspension until the PHE ends.

Each Medicare Administrative Contractor (MAC) studies the claim data submitted by each provider to determine providers who have high potential for claim error rates or unusual billing practices.  In addition, the MACs are also identifying trends for services that impose a high financial risk to Medicare.  If an agency has had high denials from Additional Documentation Requests (ADRs) in the past, they are at a high risk of being selected for the TPE program.

Common TPE claim errors include:

• The signature of the certifying provider was not included
• Face-to-Face (F2F) encounter notes did not support all elements of eligibility
• Documentation does not meet medical necessity
• Missing or incomplete initial certifications or recertifications

Click to Visit 'How the Targeted Probe and Educate Process Works' Resources