CMS Resumes Targeted Probe & Educate Program

CMS; Programs and Resources
​​​​​In it’s August 12, 2021 edition of mln connects, the Centers for Medicare and Medicaid Services (CMS) announce a resumption of the Targeted Probe & Educate Program conducted by Medicare Administrative Contractors (MACs) to help educate providers and reduce future denials and appeals. This program was suspended in early 2020 as a result of the COVID-19 public health emergency (PHE). 

Per the TPE webpage, the goal is to help providers quickly improve. MACs work with providers, in person, to identify errors and help providers correct them. Many common errors are simple – such as a missing physician's signature – and are easily corrected.

When performing medical review as part of TPE, MACs focus on specific providers/suppliers that bill a particular item or service rather than all providers/suppliers billing a particular item or service. MACs will focus only on providers/suppliers who have been identified through data analysis as being a potential risk to the Medicare trust fund and/or who vary significantly from their peers. TPE typically involves the review of 20-40 claims per provider/supplier, per item or service. This is considered a round, and the provider/supplier has a total of up to three rounds of review. After each round, providers/suppliers are offered individualized education based on the results of their reviews. Providers/suppliers are also offered individualized education during a round when errors that can be easily resolved are identified.

Additional information related to the TPE program include: