General Question for the Week of July 29, 2019

General Compliance Question of the Week


How do MACs use data in the TPE program?


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.