Please note: TPE reviews continue to be on hold due to the PHE related to COVID-19. However, the National Government Services Medical Review Department will be performing service specific post-payment reviews for claims submitted to Medicare Part A and Part B.
Effective 10/1/2017, the CMS is expanding the existing TPE pilot to include all MACs. TPE will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the ZPIC, UPIC, RAC, etc.
The goal of TPE is to reduce/prevent improper payments.
The purpose of this expansion is to reduce appeals, decrease provider burden and improve the medical review and education process.