Richter ShareSource Blog

In recent blogs, we outlined medical Medicare review strategies; explained probe and educate (PE), as well as Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; we offered strategies for preparing and submitting TPE documentation; we outlined the TPE claims review process; and we highlighted top hospice TPE denial reasons. In this blog, we will share some TPE appeal options and recommendations.

In recent blogs, we outlined medical Medicare review strategies; explained probe and educate (PE), as well as Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; we offered strategies for preparing and submitting TPE documentation; and we outlined the TPE claims review process. In this blog, we will share some of the top hospice agency TPE denial reasons.

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.

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.

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.

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:

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.

Is there a home healthcare provider who has not had to deal with “that” employee – i.e., the one who had his/her client sign a week’s worth of documentation for services they did not provide? Usually the agency does not discover fraud was committed by an employee until weeks, months or even years later. Unfortunately it is a major loophole in service provision that relies solely on paper documentation. It is because of incidences like this that the Affordable Care Act (ACA) includes a mandate for states to take measures to reduce fraud and over payments by focusing on prevention rather than the traditional “pay and chase” model of catching those who commit fraud.