Medical Record Review Results

Targeted Probe and Education (TPE) Reviews - CMS is resuming 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 - All post-payment reviews will be closed. 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 October 2023 - December 2023 included:

  • 10-Claim Preview - 7% compliance
  • Round 1 - 52% compliance
  • Round 2 - 44% compliance
  • Round 3 - 30% compliance
    • CMS Referral - 50%
 

TPE Pre-Payment Reviews

Review Criteria Current
Error
Rate		 Current Review Results
Ankle-Foot Orthosis (AFO) TPE Reviews 5% View Current Review Results
Diabetic Supplies TPE Reviews 71% View Current Review Results
Enteral Nutrition TPE Reviews 28% View Current Review Results
Hospital Beds TPE Reviews 18% View Current Review Results
Knee Orthosis TPE Reviews 73% View Current Review Results
Manual Wheelchairs TPE Reviews 68% View Current Review Results
Ostomy Supplies TPE Reviews 26% View Current Review Results
Parenteral Nutrition TPE Reviews 44% View Current Review Results
Pneumatic Compression Devices TPE Reviews 40% View Current Review Results
Positive Airway Pressure (PAP) Devices TPE Reviews 12% View Current Review Results
Spinal Orthoses TPE Reviews 29% View Current Review Results
Surgical Dressings TPE Reviews 35% View Current Review Results
Therapeutic Shoes TPE Reviews 55% View Current Review Results
Urological Supplies TPE Reviews 25% View Current Review Results

Resources

Last Updated Apr 16 , 2024