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April 6, 2020

TPE Review Update from CGS Medical Review

CMS recently published direction concerning the Targeted Probe and Educate (TPE) review strategy for their Medicare Administrative Contractors (MACs) in light of the COVID-19 Public Health Emergency (PHE).  As such, we want to alert our supplier community to the actions we are taking immediately:

  • Suspension of all current TPE reviews until further notice.
  • Release of all pending claims for payment, including those in which a response was received but a decision not yet rendered.
  • Reversal of claims denied for non-response on or after March 1, 2020, unless a Redetermination has been filed.

If you have not yet responded to a TPE request for documentation (an ADR letter) from CGS Medical Review, you can shred and dispose of the letter – please do NOT submit a response to CGS Medical Review.

Watch your Medicare Remittance Advice statements for updates on TPE claims we released.

Please note, if you have a request for documentation from another entity (i.e., the CERT contractor), you need to respond to them in a timely matter unless otherwise instructed by CMS.

Finally, please continue to monitor our daily ListServ, the CGS News webpages, and our COVID-19 webpage for additional information and updates.

Stay safe and healthy as you take care of your clients!

Update added September 24, 2021: On August 12, 2021, CMS announced the restart of the Targeted Probe and Educate (TPE) program. Refer to the following article for additional information: Resumption of the Targeted Probe and Educate (TPE) Medical Review (MR) Strategy

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