The Home Health and Hospice Targeted Probe and Educate Process
Medical Review conducts TPE on claims from all providers under the Medicare Program. Protect your revenue by gaining more knowledge regarding TPE audits.
Providers targeted for TPE will receive a notification letter (enclosed in a pink envelope) about the upcoming review and an ADR will be issued for the specific claims selected for review. Providers should respond promptly to the notification letter with the name, phone number and email address of a designated point of contact for TPE-related issues. Providers should ensure that medical records are submitted promptly upon request. Providers are highly encouraged to respond to the ADR by sending all applicable medical records prior to day 45.
Reminder: ADRs must be responded to prior to the 45 day deadline (based on the date of the ADR) for each claim selected.
Provider nonresponse to medical records requests will count as an error. Providers with an error rate of greater than 15% that do not request or accept education will be noted as a refusal. MACs may conduct a “related claim review” of services related to a denied claim and such reviews may be conducted outside of the TPE process. The TPE process does not replace or change appeal rights. The educational sessions are not an appeals forum nor do the result letters and/or the educational sessions extend the appeal period.
HH+Hs are encouraged to review the Targeted Probe and Educate section of our website for additional information on current topics under TPE.
CMS has a short video explaining the Targeted Probe & Educate “TPE” process, rounds and education.