Targeted Probe and Educate (TPE) - JA DME
Targeted Probe and Educate (TPE)
CMS resumed the Targeted Probe and Educate (TPE) program to help educate providers and reduce future denials and appeals.
How Does It Work?
- Noridian uses existing data analysis to determine item(s) and suppliers to review through TPE.
- TPE includes up to three rounds of supplier-specific prepayment probe review with a focus on one-on-one education throughout process to improve identified errors.
- Identified suppliers receive written notification from Noridian that includes topic being reviewed, reason for selection and process of review. First-round prepayment probe review will begin following notification to supplier.
What Happens During the Review?
- Throughout and after each round, suppliers will receive one-on-one education on specific errors identified.
- A 10-claim preview of Round 1 will be conducted. This preview is intended to reduce burden for compliant suppliers. If the Round 1 preview results in zero errors, no further action is required and the TPE review will be closed. If the Round 1 preview indicates errors, Round 1 will continue. Results will be communicated via telephone call or letter.
- Following education at the end of a round, suppliers are given 45 days to allow for necessary adjustments or process changes to demonstrate sufficient improvement through claim review during second-round probe review.
- If improvement in second-round probe review is not sufficient, suppliers will undergo another round of education, a 45-day improvement period and a third probe review.
- Once a supplier has reached an acceptable error rate, the TPE process will end and Noridian will notify supplier of successful completion. If sufficient improvement is achieved through claim review, discontinuation of TPE may occur after any round.
Electronic Supplier Visits
- An electronic supplier visit (e-visit) can be requested with your case manager at any time: the start of each TPE review, during a round, following each round, and at the end of TPE. This one-on-one education will be tailored to specific educational needs.
- To request an e-visit with Medical Review, contact your TPE nurse case manager.
- CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 2.5
- CMS TPE webpage