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Health Law Scan

Legal Insights and Perspectives for the Healthcare Industry

A notable headline from the August 12 MLN Connects Newsletter for healthcare providers states “CMS Resumes Targeted Probe & Educate Program.” Designed to help providers reduce claim denials and appeals, CMS suspended prepayment reviews under the Targeted Probe and Educate (TPE) program in response to the COVID-19 public health emergency (PHE) in March 2020. But unlike post-payment audits which have been active since CMS authorized its contractors to begin new audits in August 2020, TPE prepay reviews remained on hold.

The announcement offers no information as to when exactly CMS has or will resume the TPE program. Indeed, when asked during a recent update on medical review for home health and hospice, in mid-June Palmetto GBA – one of the Home Health and Hospice MACs – responded by noting “We do not have an expected date for TPE to return.” It is also important to note that Palmetto shows this webpage was last updated on August 11, 2021.

While TPE prepay audit activity may not be welcome by many providers given the additional burden of responding and attendant scrutiny, the program did offer an educational and communication vehicle with MAC reviewers that has been largely absent since March 2020. We will update this post as we learn more.

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