Medical Record Review Results

Targeted Probe and Education (TPE) Reviews - CMS created the Targeted Probe and Educate (TPE) program to help educate providers and reduce future denials and appeals. For more information on the TPE process, refer to the Targeted Probe and Educate page.

Service Specific Prepayment Reviews - Noridian has no current active Service Specific Prepayment Reviews. Prepayment reviews occur when a reviewer makes a claim determination before claim payment has been made. Prepayment reviews always result in an "initial determination."

Service Specific Post-Payment Reviews - Noridian has no current active Post-payment Reviews. Post-payment reviews occur when a reviewer makes a claim determination after the claim has been paid. Post-payment reviews result in either no change to the initial determination or a "revised determination" indicating that an overpayment or underpayment has occurred.

Supplier compliance results for all TPE reviews completed from July 2024 - September 2024 included:

  • 10-claim preview - 20% compliance
  • Round 1 - 55% compliance
  • Round 2 - 17% compliance
  • Round 3 - 0% compliance
    • CMS referral - 50%
 

TPE Pre-Payment Reviews

Review Criteria Current
Error
Rate		 Current Review Results
Ankle-Foot Orthosis (AFO) TPE Reviews 17% View Current Review Results
Diabetic Supplies TPE Reviews 33% View Current Review Results
Enteral Nutrition TPE Reviews 20% View Current Review Results
Hospital Beds TPE Reviews 47% View Current Review Results
Knee Orthosis TPE Reviews 56% View Current Review Results
Manual Wheelchairs TPE Reviews 33% View Current Review Results
Ostomy Supplies TPE Reviews 25% View Current Review Results
Oxygen TPE Reviews 13% View Current Review Results
Parenteral Nutrition TPE Reviews 14% View Current Review Results
Pneumatic Compression Devices (PCD) TPE Reviews 54% View Current Review Results
Positive Airway Pressure (PAP) Devices TPE Reviews 11% View Current Review Results
Surgical Dressing Supplies TPE Reviews 24% View Current Review Results
Therapeutic Shoes for Persons with Diabetes TPE Reviews 59% View Current Review Results
Urological Supplies TPE Reviews 27% View Current Review Results

Resources

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