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Richter ShareSource Blog

Navigating the Targeted Probe and Educate (TPE) Claims Process

In recent blogs, we outlined medical Medicare review strategies; probe and educate (PE); we explained Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; and we offered strategies for preparing and submitting TPE documentation. In this blog, we will share tips on navigating the TPE claims review process.

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Topics: Home Health & Hospice

Preparing and Submitting Documentation for Targeted Probe and Educate, Medicare’s New Medical Review Strategy

In recent blogs, we outlined medical Medicare review strategies, probe and educate (PE), and we explained Targeted Probe and Educate (TPE), Medicare’s new medical review strategy. In this chapter, we will share tips on preparing and submitting your TPE documentation.

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Topics: Home Health & Hospice

Understanding Targeted Probe and Educate – Medicare’s New Medical Review Strategy

In 2015, the Centers for Medicare and Medicaid Services (CMS) introduced the Probe and Educate (PE) strategy, first to hospitals and then to home health care agencies. With this new strategy, five claims were selected from every hospital and home health care provider. If a claim was denied, one-on-one education was offered in an effort to prevent future errors.

Targeted Probe and Educate (TPE) is a result of the positive outcomes that were generated through the PE strategy. Although hospice agencies were not included in the PE strategy, TPE was expanded to all Medicare service providers in October 2017. Unlike other strategies, with TPE, your agency will only receive an Additional Development Request (ADR) if it is shown through data analysis that you may be doing something improperly which could result in an improper Medicare payment.

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Topics: Home Health & Hospice

The Proposed Patient-Driven Payment Model (PDPM): 10 Things You Need to Know

Posted by Jennifer Leatherbarrow, RN, BSN, RAC-CT, QCP, CIC on Jun 28, 2018 9:04:00 AM

In April 2018, the Centers for Medicare and Medicaid Services (CMS) threw yet another curveball at (MDS) coordinators and skilled nursing facilities (SNFs) across the country. CMS’ original plan to introduce RCS-1 (resident classification system, the proposed new federal payment system) was overturned and replaced by the now proposed patient driven payment model (PDPM). This new payment model does have similarities to the previous RCS-1, but there were improvements made to increase payment accuracy.

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Topics: Regulatory Changes, News & Events, Clinical Consulting

5 “You-Focused” Tips to Improve Your Organization’s RCM Process

Posted by Candace LaRochelle, Revenue Cycle Manager on Jun 20, 2018 9:01:00 AM

Revenue cycle management (RCM) is so much more than just a financial process. It is about the procedures that enable your long-term post-acute care (LTPAC) organization to maintain a positive financial picture and, in turn, allow you to focus on day-to-day operations and optimal outcomes. It sounds cliché, but that is why communication is key throughout the RCM process. Poor communication at any point can cause a complete breakdown.

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Topics: Revenue Cycle Management, Financial Consulting

Is Pre-Claim Review Making a Comeback in Home Health?

Posted by Donna Berry, Revenue Cycle Manager-Home Health and Hospice on Jun 11, 2018 4:08:52 PM

On Tuesday, May 29, 2018, the Centers for Medicare and Medicaid Services (CMS) released a new proposal that would reinstate pre-claim review for home health care providers. Like previous medical review strategies, the proposed Review Choice Demonstration for Home Health Services will focus on reducing the rate of improper payments and improving provider compliance. Unlike previous medical review strategies, this proposed demonstration will give home health providers the choice of three options:

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Topics: Home Health & Hospice

An Explanation of Medicare Medical Review Strategies

Posted by Donna Berry, Revenue Cycle Manager-Home Health and Hospice on Jun 5, 2018 11:23:08 AM

If you’ve worked in the hospice realm for any length of time, you may be familiar with Additional Development Requests (ADRs). An ADR is a request for medical documentation to ensure proper payment for provided Medicare services. Claims are selected based on specific parameters set by the Centers for Medicare and Medicaid Services (CMS).

ADRs have been around for years. In 2017, CMS introduced a new ADR strategy—Targeted Probe and Educate (TPE). TPE requests are designed to help hospice providers reduce and prevent improper payments, reduce appeals, decrease provider burden and improve the medical review and education process.

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Topics: Home Health & Hospice

Employee Engagement Part III: A Necessary Foundation for Organizational Success

Posted by Reba Allison, BCP, Director of Human Resources on May 22, 2018 8:54:00 AM

This post is Part III in our Employee Engagement Series. Click here for Part I or here for Part II.

Click here for our helpful infographic on employee engagement stats and why they matter to your LTPAC organization.

Throughout your long-term post-acute care (LTPAC) organization, there should be individuals at every level driving employee engagement and cultivating sustainable change. 

Employee engagement is not a quick fix for any issues you may be facing. It takes time and effort and most importantly, it takes a commitment from all stakeholders, especially management. The change to an engaged workforce must be a deliberate, consistent, ongoing process that inherently becomes a way of doing things. 

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Topics: Employee Engagement