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When Medicare claims are submitted accurately, everyone benefits. That is the philosophy behind the Targeted Probe and Educate (TPE) program. The review is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help. Estes Park Health’s wonderful Patient Financial Services department had a big win recently! Estes Park Health was selected for prepayment review on […]
While not new, the number and scope of Targeted Probe and Educate (TPE) reviews have soared to new heights. At the same time, more hospices are facing the uncomfortable position of...
A new federal review process designed to lessen improper government payments is sending provider staffs scurrying to justify their coding.
On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a new nationwide audit of all skilled nursing facilities (SNF) and Hospital swing bed providers that submit...
The Medicare appeals process starts well before the first level listed above when a provider receives a medical records request, also known as an additional records request. These requests can come from different Medicare contractors, for example, a MAC or a UPIC.