Situation Report | August 16, 2021
The U.S Centers for Medicare and Medicaid Services (CMS) announced the resumption of Targeted Probe & Educate (TPE) program to help educate Medicare providers and reduce future denials and appeals.
The TPE program is intended to increase accuracy in agency’s billing practices and the Medicare Administrative Contractors (MACs) such as National Government Services (NGS) here in New York use data analysis to identify:
- Providers and suppliers who have high claim error rates or unusual billing practices; and,
- Items and services that have high national error rates and are a financial risk to Medicare.
Providers whose claims are compliant with Medicare policy will not be chosen for TPE.
If NGS audits you, CMS encourages agencies to take advantage of the TPE education and get up to 3 rounds of educational claim review to help your agency bill accurately.