Sometimes what you don’t know can hurt you. The MACs have their marching orders from CMS: find those providers that bill for “items/services that pose the greatest financial risk to the Medicare trust fund and/or have the highest claim error rates or billing practices that vary significantly out from their peers”. These orders will be carried out through a targeted probe and educate (TPE) campaign.
What is different with this probe and educate? Volume for one thing. If your agency is targeted, you will be asked to submit 20-40 charts. Where they find errors/non-compliance, you will be invited to participate in a one-on-one educational session. Agencies with moderate to high error rates will continue on to the second round of 20-40 charts, and then a third.
If after three rounds there is still little improvement, an agency will be referred to CMS for additional action which could include 100% pre-pay review, extrapolation, or referral to a recovery auditor. Agencies showing sufficient improvement may be removed from the review process at any time.
If you’re targeted, be one of those organizations that shows improvement on the first round. Not sure what that means or what to do? Come to the ADR to Appeal Primer and learn from Joe Osentoski, one of the country’s leading experts on home health compliance.
We recommend you remain educated on this topic: the law does not excuse for ignorance.