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Richard S. Cooper. Esq., Member, McDonald Hopkins LLC

CMS's Targeted Probe and Educate ("TPE") Program - Get Counsel Involved Early!


By Richard S. Cooper, Esq.
Member
McDonald Hopkins LLC



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Original Publish Date: February 6, 2018

On October 1, 2017, CMS expanded its pilot Targeted Probe and Educate (“TPE”) program to include all MACs. CMS’s stated purpose for the expansion is “to reduce appeals, decrease provider burden, and improve the medical review/education process.” CMS has described the program as “designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.” This is a 3-round program conducted by the provider’s local MAC. It offers one-on-one education and is intended to reduce payment error rates for the provider. Hopefully, the provider is also able to use the program to avoid an overpayment demand or payment suspension.

How the TPE Program works:

It is important for providers to note that the TPE process does NOT toll the appeal process under Medicare and those deadlines are still in effect.

We anticipate our clients will soon begin to see these TPE notification letters. We encourage you to engage us as soon as you receive the first letter so that we can assist you in creating a compliant response during the first round, if possible, to avoid unnecessary burden to your daily business.

Mr. Cooper provides legal representation to a broad range of hospitals, other healthcare facilities and physician groups across the United States. He has been listed in The Best Lawyers in America for health law for twenty-three consecutive years and selected for inclusion in Ohio Super Lawyers (2005-2015).

Visit the McDonald Hopkins LLC web site at www.mcdonaldhopkins.com.