MACS, RACS, ZPICS…and now TPEs….Oh my!


Over the past few years, we have all, unfortunately, gotten used to many different audits. The latest one, CMS has engaged different MACs in doing the process of the TPE – Targeted Probe and Education. The premise of these audits is related to “The process is only used with those who have high denial rates or unusual billing practices. If you are chosen for the program, the goal is to help you quickly improve. Often, simple errors – like missing a signature – are to blame. The process is designed to identify common errors in your submissions and help you correct them.” (as cited per CMS).

This process goes like this:

  • If chosen for the program, you will receive a letter from your Medicare Administrative Contractor (MAC)

  • The MAC will review 20-40 of your claims and supporting medical records

  • If compliant, you will not be reviewed again for at least 1 year on the selected topic

  • If some claims are denied, you will be invited to a one-on-one education session.

  • You will be given at least a 45-day period to make changes and improve.

  • And then the cycle starts all over again

More information regarding this can be found here.

image courtesy of CMS

image courtesy of CMS

We here at Broad River Rehab have assisted many customers with this process and have over 80% of our clients were found in compliance after the first round. Our remaining clients were found in compliance after the second round. Our knowledge of the TPE process gives our clients a much better pass rate in the first round. Please contact us if you would like more information on the TPE process.