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FAQ:Targeted Probe and Educate Program

Published on 

Tuesday, January 8, 2019

 | RAC Information 
 | FAQ 

Q:

I am new to Case Management and am looking for resources to learn more about the Targeted Probe and Educate Process




A:

The Targeted Probe and Educate (TPE) Program was preceded by two pilots before CMS and the Medicare Administrative Contractors (MACs) implemented the national TPE Program on October 1, 2017. There are several resources available through CMS and the MACs for you to learn more about this Program.

Change Request (CR) 10876

CR 10876 was released August 17, 2018. The purpose of this change request was to create a new sub-section in section 3.2.5 of Chapter 3 of The Medicare Program Integrity Manual. This new section in the manual walks you through an overview of the Program, Provider Selection, TPE One-On-One Education, Post Probe Activity and Referrals.

Link to CR 10876: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018-Transmittals-Items/R819PI.html

Link to Medicare Program Integrity Manual (Publication 100-08): https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019033.html

CMS TPE webpage

CMS has created a TPE webpage within the Medicare Review and Education section of the CMS website. This page provides the following:

  • 5 Minute Video about the Program,
  • Common claim errors,
  • An infographic detailing how the Program works, and
  • Additional resources to learn more about the TPE Program.

Link to CMS TPE webpage: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Targeted-Probe-and-EducateTPE.html

Palmetto GBA Jurisdiction J 2019 Medical Review Hot Topic TPE Teleconferences

Palmetto GBA has posted their TPE teleconference schedule for 2019 for the MAC Jurisdiction J which includes Alabama, Georgia, and Tennessee. Calls are held quarterly, are open to all providers and provide a chance to listen to their Medical Review Subject Matter Experts as they discuss and answer your questions regarding the TPE Process.

Link to Teleconference Schedule:  https://www.palmettogba.com/event/pgbaevent.nsf/SeriesDetails.xsp?EventID=B74TM73304

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.