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Preparing for Hospice Targeted Probe and Educate (TPE)

Posted on Thursday, December 14, 2017 4:15 PM

This past October, CMS replaced the Progressive Correction Action (PCA) with the medical review process, Targeted Probe and Educate (TPE).  Each of the Medicare Administrative Contractors (MAC) are now choosing topics to review under TPE based on existing data analysis procedures.

Per NAHC, hospices should realize that the goal of TPE is to reduce and prevent improper payments. 

“Second, hospices should realize that CMS and the MACs have published some areas within the hospice benefit which could be at risk for improper Medicare payment via the target areas on the PEPPER and previous MAC medical review topics.  Hospices should look at these areas for possible TPE topics.  Hospice PEPPER target areas this year included:

  • Live discharges not terminally ill
  • Live discharges revocation
  • Live discharges 61-179 days
  • Long length of stay (defined as >180 days)
  • Routine home care in assisted living facility
  • Routine home care in nursing facility
  • Routine home care in skilled nursing facility
  • Claims with single diagnosis coded
  • No General Inpatient Care (GIP) or Continuous Home Care (CHC)”

Any hospice that performs at or above the 80th Percentile for any PEPPER target may be at a greater risk for an improper Medicare payment.

A final note – the MACs have requested that we underscore that it is essential when responding to TPE ADRs that providers include the name and number of the designated contact person.  This will help to facilitate subsequent discussion of the review findings between the MAC and the provider.”

Source NAHC Report


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