Creator: Patrick Connole
Quick Update: Change for MAC and TPE Audits
Starting on Nov. 2, Medicare Administrative Contractors must start reporting reasons for their Target, Probe and Educate audits at least quarterly.
A month from now on Nov. 2, Medicare Administrative Contractors (MACs) have to start reporting reasons for their Target, Probe and Educate (TPE) audits at least quarterly on MAC websites.
Alicia Cantinieri, managing director of clinical reimbursement and regulatory compliance for Zimmet Healthcare Services Group, said on Sept. 30, CMS Transmittal 13971 released, which includes updates to Publication 100-8, Medicare Program Integrity Manual, Chapter 3, Section 3.7.1.1.
“This update requires all MACs to post quarterly TPE results on their websites, identifying the three most common denial reasons for each prioritized review topic,” she told Park Place, where she is a regular contributor.
“These postings will help providers and suppliers—including SNFs—stay informed about issues and trends identified through medical review. The requirement applies to Part A, Part B, home health and hospice, and SNFs.”
Many MACs, she noted, already publish this information, although review topics and reporting periods vary.
“The requirement can be helpful; however, keep in mind that the memo and the manual state only the top three reasons for a specific topic, not necessarily all topics, which may mean that for any one MAC, the results of SNF TPEs may not make the site.,” Cantinieri said.
CMS said TPE is meant to aid providers’ claim accuracy through targeted review and individualized education.
“The purpose of this Change Request is to require the Medicare Administrative Contractors to post TPE results on their websites in an effort to keep the provider and supplier communities informed of issues and trends,” the agency said.
Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.
