Targeted Probe & Educate (TPE)

The objectives of Targeted Probe & Educate are:

• Identify/prevent inappropriate payment

• Identify potential risk to the Medicare Trust Fund

• Educate providers

• Pay for covered services appropriately

• All of these

Providers receive TPE ADRs in an _________ envelope:

• Bright Yellow

• Bright Blue

• Bright Pink

• Bright Orange

How are TPE reviews selected?

• Data analysis

• Improper payment reduction strategy

• CMS instruction

• All of these

When do I start sending records for TPE review?

• When I receive the Provider Notification letter

• When I receive the ADRs

• When I hear my specialty is being reviewed

• When I receive the Detailed Provider Results letter

How many days will transpire between each probe allowing you to implement corrections?

• 45-56 days

• 30-44 days

• 57-75 days

Providers can request one-on-one education on errors found after receiving the detailed provider results letter:

• True

• False

The MAC will request _________ claims per review round:

• 1-15

• 20-40

• 45-60

• 75+

TPE consists of three rounds if the provider continues to have a high payment error rate above:

• 10%

• 15%

• 20%

• 25%

After three rounds of review and continued high denial rates, the MAC will refer the provider to CMS for corrective actions which could include:

• Extrapolation

• Referral to the Zone Program Integrity Contractor (ZPIC) or Unified Program Integrity Contractor (UPIC)

• Referral to the Recovery Audit Contractor (RAC)

• 100% pre-payment review

• All of these

Can a TPE review be appealed?

• Yes

• No