tci Medicare Compliance & Reimbursement - 2017 Issue 19

Medical Review: Don't Be a Moving Target — Clean Up Your Claims Now

All MACs will now perform Targeted Probe and Educate audits. With assurances to decrease Medicare providers’ administrative burdens, CMS has made good on its promise. But for those whose claims are often found in error, the paperwork may be the least of your concerns. Background: CMS decided over the summer to update its successful Probe and Educate medical review program, originally initiated in 2014. This past June, the agency upped its strategies, using first one of its Medicare Administrative Contractors (MACs) as a “pilot” for a more focused claims review process called Targeted Probe and Educate (TPE). Then...

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