Medical Record Review Results - JD DME

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 January 2024 - March 2024 included:

• 10-Claim Preview - 41% compliance
• Round 1 - 59% compliance
• Round 2 - 20% compliance
• Round 3 - 60% compliance
  • CMS Referral - 20%

Resources

• CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 3