Targeted Probe and Educate

Targeted Probe and Educate

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?

The signature of the certifying physician was not included. Encounter notes did not support all elements of eligibility. Documentation does not meet medical necessity. Missing or incomplete initial certifications or recertification.

How does it work?

Diagram of the Targeted Probe and Educate program with the following information: If chosen for the program, you will receive a letter from your Medicare Administrative Contractor (called a MAC). The MAC will review 20 to 40 of your claims and supporting medical records. If some claims are denied, you will be invited to a one-on-one education session. You will be given at least 45 days to make changes and improve, before another 20-40 claims are reviewed. This can happen up to 2 additional times. If compliant, you will not be reviewed again for at least 1 year on the selected topic.

*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).

Page Last Modified:
09/06/2023 04:57 PM