General Question for the Week of September 10, 2018

Question:

What is a TPE review, and what is its purpose?

Answer:

According to the Centers for Medicare & Medicaid Services, the purpose of Targeted Probe and Educate (TPE) is to decrease provider burden, reduce appeals, and improve the medical review/education process. TPE reviews can be either prepayment or postpayment, and a round of TPE typically involves the review of 20–40 claims, per provider or supplier, per service or item, and corresponding education. In rare circumstances, CMS may approve a probe sample of other than 20–40 claims. This process is repeated for up to three rounds. MACs discontinue the process if/when providers and suppliers become compliant. Those who remain non-compliant after three rounds of TPE are referred to CMS for further action.