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CMS to narrow scope of claims documentation audits

09/18/2017 3:23 PM | Rebekah Francis (Administrator)

CMS announced last month it will launch a new audit strategy, called Targeted Probe and Educate (TPE), after pilot programs with four Medicare Administrative Contractors (MACs) demonstrated success. Under the TPE approach, MACs will perform reviews on claims that pose the greatest financial risk to the Medicare trust fund or have a high national error rate. Unlike the previous policy where reviews were initiated on all providers of a particular service, MACs are now instructed to focus only on those providers, identified through data analysis, who have the highest claims error rates or billing practices that vary significantly from their peers. The TPE program includes up to three rounds of review, coupled with individualized education based on review results, and is expected to be expanded to all MAC jurisdictions - later this year.


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