Targeted Probe and Educate

Effective 10/1/2017, CMS is expanding the existing Targeted Probe and Educate (TPE) pilot to include all Medicare Administrative Contractors (MACs). TPE will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc. The goal of TPE is to reduce/prevent improper payments. The purpose of this expansion is to reduce appeals, decrease provider burden, and improve the medical review and education process. All current MAC medical record reviews are replaced with three rounds of pre-payment or post-payment TPE. If the provider's error rate remains high upon completion of the first round, then the provider is retained for the second and, potentially, a third round of review.


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