tci Medicare Compliance & Reimbursement - 2019 Issue 2
Targeted Probe And Educate: Watch Your Subsequent Care Coding, Medical Reviews Suggest
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Article Overview
This article covers Medicare prepayment medical review activity focused on subsequent hospital care evaluation and management services, with attention to how several Medicare Administrative Contractors reported probe results, denial trends, and education efforts. It is written for coders, billing staff, compliance teams, and providers who need to understand the scope of the review process, the kinds of documentation and billing issues being discussed, and which organizations and jurisdictions are involved.
Why This Topic Matters
The topic matters because targeted Medicare reviews can affect claim payment, denial rates, and compliance workflows for commonly billed hospital care services. Understanding the review environment helps coding and billing teams track where audits are occurring and what broad issues are driving review activity.
Article Sections
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Here’s a TPE Refresher
Provides a general overview of Medicare Targeted Probe and Educate review activity, including how the process is structured and how providers are notified. It also summarizes the timing, education, and follow-up framework used by MACs.
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Check Out the Latest Subsequent Care Codes’ TPE Stats
Summarizes recent Medicare review activity and published probe information for subsequent hospital care services across several MACs. The section compares jurisdictions and describes the broad types of review findings discussed in the article.
What You Will Learn
- How Medicare Targeted Probe and Educate reviews are generally organized
- Which MACs are discussing review activity for subsequent hospital care services
- What broad categories of issues appear in probe and denial reporting
- How different jurisdictions are presenting review status and education information
- Why subsequent care E/M services are attracting medical review attention
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Revenue cycle staff
- Physicians and hospital-based providers
- Practice managers
Codes Discussed
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