Compliance: Conquer Claims Reviews with These 5 Tips

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains how Medicare’s Targeted Probe and Educate (TPE) program is being implemented by MACs and why it matters to providers facing medical review. It covers the general structure of the program, the types of administrative follow-up involved, and operational steps organizations are encouraged to consider when responding to review activity. The piece is aimed at billing, compliance, and management staff who need to understand the evolving audit environment and related contractor processes.

Why This Topic Matters

TPE can affect claim review workload, documentation handling, and provider education activities across Medicare jurisdictions. Understanding the program’s structure and operational expectations helps organizations stay prepared for ongoing review cycles and related contractor communications.

Article Sections

  1. TPE program overview

    Introduces the Medicare Targeted Probe and Educate program and summarizes its role in contractor medical review operations. Explains the broader compliance context and the shift in review focus.

  2. Take These Measures To Tackle TPE

    Outlines general operational tips for responding to TPE activity, including coordination, management oversight, staff awareness, and documentation handling. Also points readers to program details and evolving contractor guidance.

What You Will Learn

  • How the TPE program fits into Medicare compliance activity
  • What operational areas are affected when a provider is selected for review
  • Why management, billing, and clinical teams need coordinated processes
  • How contractor communication and document submission workflows factor into review response
  • What kinds of program updates providers should monitor over time

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance officers
  • Practice managers
  • Revenue cycle teams
  • Medicare providers

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