The Consistency of TPE Failure Rates

Home health agencies undergoing TPE reviews continue to fail at impressive rates for the same reasons as previous reviews. Let's talk about the consistency of TPE failure rates and how they link to RCD, PDGM, and more.

Backlog to the Future? Part 3

Home care agencies who have received additional development requests (ADRs) are experiencing an ever-increasing ALJ backlog. The following is the final part of a 3-part series on the current state of ADRs and the ALJ backlog.

Backlog to the Future? Part 2

Home care agencies who have received additional development requests (ADRs) are experiencing an ever-increasing ALJ backlog. The following is part 2 of a 3-part series on the current state of ADRs and the ALJ backlog. Find Part One here. As we mentioned last week, a federal judge ruled that OMHA must seek to reduce the ALJ backlog... Continue Reading →

Backlog to the Future? Part One: The State of ALJs

Home care agencies who have received additional development requests are experiencing an ever-increasing ALJ backlog. An additional development request (ADR) is generated to request documentation from a provider to assist with adjudicating a Medicare claim. Since 2010, the number of claims awaiting an Administrative Law Judge (ALJ) hearing has steadily climbed, along with the wait time for... Continue Reading →

Low Volume Appeals (LVA) Initiative Settlement Option – Part 2

The Low Volume Appeals Settlement Process, also known as LVA, is a new option for agencies who are waiting for ALJ hearings or MAC/DAB reviews. Take advantage of this opportunity to settle fully-denied claims.  

Targeted Probe and Educate: What It Is and What It Isn’t

CMS has replaced the Progressive Corrective Action (PCA) ADR/Medical Review process with Targeted Probe & Educate (TPE). With this change comes a different approach to reviews and how Additional Development Requests (ADRs) are sent to agencies. Much of PCA is still present, but with some key changes, so TPE is not the same old process. Check out our comprehensive list of what TPE IS and what TPE IS NOT.

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