Source: Emily Hill, PA, AAPM Coding Consultant
Date: February 7, 2018
In October 2017 CMS launched a nationwide program to better target medical review, limit the number of medical records requested, and put an emphasis on education and assistance in correcting claims errors. The goal is to help identified providers and practices by having Medicare Administrative Contractors (MACs) work in person with the practice to identify specific errors and help correct them quickly.
Most providers will never need TPE. The program focuses on providers who have unusual billing patterns or billing practices that vary greatly from their peers. Practices will receive a letter if chosen for the program and CMS will request 20-40 claims with the accompanying documentation. If found compliant, then you will not be reviewed for at least one year on the identified topic. If denials are identified, you will be invited to a one-on-one education session and have 45 days to make changes and improve. The session will likely be held via teleconference or webinar and the provider will have the opportunity to ask questions about their specific claims as well as the underlying CMS policy.
View information on TPE. The page includes links to TPE Q&A documents as well as a one-page information sheet.