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Targeted Probe and Educate (TPE)

CMS has authorized Noridian to conduct the Targeted Probe and Educate (TPE) review process. This is a required process for providers targeted by Medical Review. The TPE process includes up to three rounds of pre-payment probe review with education. If there are continued high errors after the first three rounds, Noridian will refer the provider to CMS. CMS will determine additional action, which may include extrapolation, referral to Recovery Audit Contractor (RAC), 100% pre-payment review, etc.

Note: Discontinuation of review may occur after any round if appropriate improvement is achieved.

The key elements include:

  • Providers reviews will consist of up to three rounds of pre-payment TPE probe process. Noridian will select topics for review and providers based on existing data analysis procedures outlined in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 2
  • Noridian will notify providers in writing on the topic being reviewed, reasons for selection, and process of review
  • Noridian may refer providers, to RAC or UPIC, if providers do not respond to ADR requests by submitting requested documentation
  • If warranted, education will be offered to the provider throughout the TPE process. Additionaly, at the end of each “round”, Noridian will provide claim review findings in writing and education on potential errors identified. Providers with idenitifed errors during review will receive an offer for one-on-one education related to specific errors identified. Goal for providers is to learn from education and improve their results in the subsequent round to decrease errors
    • Providers will be moved to a subsequent round if errors remain high
    • A subsequent round will not be initiated if the provider has decreased errors; however, Noridian will continue to monitor data
  • Providers with continued high errors after three rounds of pre-payment TPE reviews will be referred to CMS for further action

If selected for this review, providers are not excluded from other Medical Review activities, such as, automated reviews, comparative billing reports, mandated demand bill reviews, pilot review strategies, etc. as directed by CMS or other contractor reviews. Additionally, Noridian will continue to work with other CMS contractors and collaborate with referrals back and forth to Quality Integrity Organization (QIO) for concern of quality care, UPIC for concerns related potential fraud/abuse, and RAC for collaboration of vulnerability and ensure ther is no duplication of reviews.

To watch a CMS video to learn more about TPE go to Targeted Probe and Educate.


Last Updated Mon, 13 Sep 2021 15:16:13 +0000