Medicare Administrative Contractors use data analysis to identify specific areas of compliance: (1) providers and suppliers who have high claim error rates or unusual billing practices, and (2) items and services that have high national error rates and are a financial risk to Medicare. Providers whose claims are compliant with Medicare policy won't be chosen for TPE.
Related Resources
- CMS: Targeted Probe and Educate
- Understanding Targeted Probe and Educate
PT in Motion Magazine (July 2018) - CMS MAC Claims Review Process Will Move to More Targeted System
PT in Motion News (August 2017) - Visit Your Medicare Administrative Contractor's Website
This website will provide information on TPE specific to your jurisdiction, including current TPE review topics - Email your feedback on TPE to CMS