General Question for the Week of July 29, 2019

Question:

How do MACs use data in the TPE program?

Answer:

The Targeted Probe and Educate (TPE) program tries to raise accuracy in specialized areas regarding claims and billing practices. According to the Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractors (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.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

General Question for the Week of July 29, 2019

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