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.
NAVIGATING THE NEXT.
Sharing insights and resources that help our clients prepare for and address evolving issues is a hallmark of Morgan Lewis. To that end, we maintain a resource center with access to tools and perspectives on timely topics driven by current events such as the global public health crisis, economic uncertainty, and geopolitical dynamics. Find resources on how to cope with the globe’s ever-changing business, social, and political landscape at Navigating the NEXT. and Coronavirus COVID-19 to stay up to date on developments as they unfold. Subscribe now if you would like to receive a digest of new updates to these resources.