tci Medicare Compliance & Reimbursement - 2022 Issue Q4

Reader Question: Stay Abreast of TPE and Other Medical Review Updates

Question: How concerned should we be about medical record reviews by the Centers for Medicare & Medicaid Services (CMS) since the COVID-19 public health emergency (PHE) is still ongoing and may be extended through the end of the year? New York Subscriber Answer: Stay vigilant. While CMS put many investigations and reviews on pause during the pandemic, medical reviews have picked back up. Some experts say that the agency may be looking at medical records of Medicare Parts A and B beneficiaries through additional development requests (ADRs) and Targeted Probe and Educate (TPE) programs for a rationale to support...

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