Medical Record Review Results - JA DME
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 April 2024 - June 2024 included:
- 10-claim preview - 25% compliance
- Round 1 - 61% compliance
- Round 2 - 50% compliance
- Round 3 - 100% compliance
- CMS referral - 0%
TPE Pre-Payment Reviews
Review Criteria | Current Error Rate |
Current Review Results |
---|---|---|
Ankle-Foot Orthosis (AFO) TPE Reviews | 12% | View Current Review Results |
Diabetic Supplies TPE Reviews | 26% | View Current Review Results |
Enteral Nutrition TPE Reviews | 22% | View Current Review Results |
Hospital Beds TPE Reviews | 16% | View Current Review Results |
Knee Orthosis TPE Reviews | 37% | View Current Review Results |
Manual Wheelchairs TPE Reviews | 7% | View Current Review Results |
Ostomy Supplies TPE Reviews | 13% | View Current Review Results |
Oxygen TPE Reviews | 16% | View Current Review Results |
Parenteral Nutrition TPE Reviews | 22% | View Current Review Results |
Pneumatic Compression Devices (PCD) TPE Reviews | 43% | View Current Review Results |
Positive Airway Pressure (PAP) Devices TPE Reviews | 10% | View Current Review Results |
Spinal Orthoses TPE Reviews | 90% | View Current Review Results |
Surgical Dressings TPE Reviews | 22% | View Current Review Results |
Therapeutic Shoes TPE Reviews | 54% | View Current Review Results |
Urological Supplies TPE Reviews | 2% | View Current Review Results |