decisionhealth Newsletters, Part B News - 2017 Issue 10 (October)
Prepare for new rules, scope of your MAC’s medical review process
Subscribe or sign in to view the full article.
Article Overview
This article covers CMS’s revamped Targeted Probe and Educate (TPE) medical review process and how it affects Medicare providers, practice operations, and compliance workflows. It is aimed at coders, billers, compliance staff, and provider offices that may receive a MAC review letter and need to understand the broad structure of the process, education opportunities, timelines, and possible downstream review actions. The discussion focuses on the scope of the review, the multi-round process, communication from the MAC, and general preparation steps to reduce disruption and revenue risk.
Why This Topic Matters
Understanding the TPE process helps practices recognize MAC review notices, respond within required timelines, and avoid escalation to more intensive review or payment disruption. The article is relevant for organizations trying to maintain Medicare billing compliance and minimize operational risk.
Article Sections
-
Overview of the revamped medical review process
Introduces CMS’s updated approach to targeted medical review and explains the broad change in how MAC audit activity is directed.
-
Know what to expect
Describes the general sequence of the review process, including initial communication, review rounds, education opportunities, and possible outcomes.
-
3 tips to prepare for TPE
Summarizes practical preparation topics such as maintaining current contact information, tracking deadlines, and using available education during the review process.
What You Will Learn
- How CMS’s targeted medical review framework is structured at a high level
- What kinds of communications a provider may receive from a MAC
- How the review process is staged over multiple rounds
- Why education and timely responses are part of the process
- What general operational steps practices should review before and during a TPE audit
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Provider offices participating in Medicare fee-for-service
- Healthcare consultants
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com