When Medicare Claims are submitted accurately, everyone benefits.
CMS's Targeted Probe and Educate (TPE) program is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.
The goal: to help you quickly improve. Medicare Administrative Contractors (MACs) work with you, in person, to identify errors and help you correct them. Many common errors are simple – such as a missing physician's signature – and are easily corrected.
Most providers will never need TPE.
TPE is intended to increase accuracy in very specific areas.
MACs use data analysis to identify:
- providers and suppliers who have high claim error rates or unusual billing practices, and
- items and services that have high national error rates and are a financial risk to Medicare.
Providers whose claims are compliant with Medicare policy won't be chosen for TPE.
What are some common claim errors?
How does it work?
*MACs may conduct additional review if significant changes in provider billing are detected
What if my accuracy still doesn't improve?
This should not be a concern for most providers. The majority that have participated in the TPE process increased the accuracy of their claims. However, any problems that fail to improve after 3 rounds of education sessions will be referred to CMS for next steps. These may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action.
Learn More About the TPE Program
View, print or share information on the new TPE program with this simple one-pager (PDF).
For further details and information about the TPE program, check out this list of TPE Q&As (PDF).