Targeted Probe and Educate (TPE)
The Centers for Medicare & Medicaid Services (CMS) is resuming the Targeted Probe & Educate (TPE) process, effective September 1, 2021. Based on data analysis of claims payment, CGS will identify areas with the greatest risk of inappropriate program payment. You may reference the Medical Review Activity Log for a list of review topics. Previous post-payment service-specific reviews will be phased out.
Process
Resources
- MR Fact Sheet
- Navigating the Process: Target, Probe, and Educate (TPE) Video
- CMS Targeted Probe and Educate (TPE) Web Page
- CMS Publication 100-08 Medicare Program Integrity Manual, Section 3.2.5
- CMS Publication 100-02, Medicare Benefit Policy Manual
- Additional Documentation Requests (ADRs): What to Send
- Top Provider Questions – Targeted Probe and Educate
- When You Don’t Respond to Additional Documentation Requests (ADRs): Quick Reference Guide
Updated: 06.16.23