General Question for the Week of September 10, 2018

General Compliance Question of the Week

Question:

What is a TPE review, and what is its purpose?

Answer:

According to the Centers for Medicare & Medicaid Services, the purpose of Targeted Probe and Educate (TPE) is to decrease provider burden, reduce appeals, and improve the medical review/education process. TPE reviews can be either prepayment or postpayment, and a round of TPE typically involves the review of 20–40 claims, per provider or supplier, per service or item, and corresponding education. In rare circumstances, CMS may approve a probe sample of other than 20–40 claims. This process is repeated for up to three rounds. MACs discontinue the process if/when providers and suppliers become compliant. Those who remain non-compliant after three rounds of TPE are referred to CMS for further action.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.