By
OPPS rule could result in higher revenue. Whenever a rule changes, expect Recovery Audit Contractor (RAC) and/or targeted probe-and-educate (TPE) audits to hone in on the topic associated with the altered rule – and expect auditors to forget when the rule actually changed. Physician supervision has been a hot topic…
By
Three risks, in particular, are expected to pose a greater liability for providers. As we get ready to say goodbye to another year of audits and investigations, compliance officers around the country have worked or are working to determine their audit elements for calendar year 2020, in response to the…
By
Noridian uses scenarios for the parenteral administration of iron in non-dialysis patients. The Noridian iron infusion Local Coverage Determination (LCD) is important for just about everyone since Noridian is the Supplemental Medical Review Contractor (SMRC). Noridian could end up reviewing and denying your claims even if you’re not in Noridian’s…
By
Understanding why there’s a need for auditing the auditors. I frequently encounter complaints by healthcare providers that when they are undergoing Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), and, more recently, the Targeted Probe-and-Educate (TPE) audits, the auditors are getting it wrong. That’s as in, during a RAC audit,…
By
TPE audits appear to be on the rise. The old baseball adage, “three strikes and you’re out,” now has relevance in the Medicare audit arena. Targeted probe and educate (TPE) audits are the latest type of audits facing Medicare providers and suppliers. TPE audits are unique in that, unlike other…
By
The Centers for Medicare & Medicaid Services (CMS) announced Monday that it would start a new national audit strategy titled Targeted Probe and Educate (TPE) after pilot programs with four Medicare Administrative Contractors (MACs) demonstrated success.  CMS described that success as “including an increase in the acceptance of provider education…