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Let’s talk targeted probe-and-educate (TPE) audits – again. I received quite a bit of feedback on my recent RACmonitor article regarding Medicare TPE audits being a “wolf in sheep’s clothing.” So I decided to delve into more depth by contacting providers who had reached out to me to discuss specific…
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Let’s talk targeted probe-and-educate (TPE) audits. TPE audits have turned out to be “wolf audits” in sheep’s clothing. The Centers for Medicare & Medicaid Services (CMS) asserted that the intent of TPE audits is to reduce provider burden and appeals by combining medical review with provider education. But the “education”…
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Initial round of audits proves successful for therapy providers. Therapy providers in the Novitas JL jurisdiction have received good news on the initial round of targeted probe-and-educate (TPE) audits.  A total of 93 percent of the 102 therapy reviews received a “minor classification.” Of note, a minor classification can include…
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Release of outdate guidelines raises fears that other MACs might adopt them to audit providers. The use of outdated definitions of malnutrition by a Medicare Administrative Contractor (MAC) is raising concerns that other MACs may adopt the same flawed practice. The universally accepted definitions, known as the American Society for…
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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…