WorksheetsTargeted Probe & Educate (TPE)
Total questions: 10
Worksheet time: 5mins
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
