General

General Question for the Week of July 29, 2019

General Compliance Question of the Week

Question:

How do MACs use data in the TPE program?

Answer:

The Targeted Probe and Educate (TPE) program tries to raise accuracy in specialized areas regarding claims and billing practices. According to the Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractors (MACs) 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.