Question:

What happens if claim accuracy doesn’t improve under the TPE?

Answer:

Under the Targeted Probe and Educate (TPE) program, the Centers for Medicare & Medicaid Services (CMS) states that failing to improve accuracy should not be a problem for most providers. But they do note that problems which fail to improve after three rounds of education sessions will be referred to CMS for next steps stating, “these may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action.”

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