Targeted Probe and Educate

September 15, 2019 0 By Ronny Jaskolski


Hi This video is about mistakes
on Medicare claims and a new, simpler way to help
you identify and correct them. First of all, everyone makes
mistakes. All of us. leisure suits the gadgets we buy from
infomercials at 3 a.m those weird wrinkled cats
that look like Yoda. You make mistakes and
I make mistakes. This tie hiring my brother-in-law to be
my financial advisor. Unfortunately, mistakes can make
our lives difficult. Mistakes on Medicare claims and
incomplete supporting documents
mean delays in getting
reimbursed or not getting reimbursed at all. And no one — not you, not us
at the Centers for Medicare and
Medicaid Services wants valid Medicare claims to
get caught up in a review
process because of an easily
corrected mistake. So we’ve come up with a new
audit process that’s simpler
and more collaborative. So we’ve come up with a new
audit process that’s simpler
and more collaborative. It’s designed to help you eliminate mistakes
and omissions that can cost you
time and money. Now, before I explain how this
works, I want to make an
important point: Many of the mistakes we see
are easy to fix. This one is missing the doctor’s
signature This one is missing notes from
the doctor to explain why the patient
needs a wheel chair and this one needs the initial
certification to support that the patient
is eligable for home care By working with you to
identify these common mistakes we can help you make
Medicare claim reimbursement
much easier. Maybe as easy as changing this
tie. thanks Maybe you could could give my
brother-in-law a few tips? Okay Here’s a quick look at how our
new audit process works it’s called it’s called targeted
probe and educate Most providers never need TPE. it’s designed for providers with
high denial rates or unusual
billing practices. If you’re selected for a
TPE audit a Medicare Administrative
Contractor what we call a MAC will review 20 to 40 of your
claims and supporting medical
records. If the review shows you’ve had
denied claims you will get a one-on-one
education session to show
you how to fix it. I’m here in the gym to show you
want we mean by doing
“one-on-one education sessions.” We won’t actually make you go
to the gym to do them but doing these sessions as
part of TPE is like working out
with a personal trainer. Some of us need help doing our
workouts Our technique is off. We repeat the same little
mistakes over and over, and that keeps us from getting
the results that we want. In TPE, you can eliminate those
little mistakes with education sessions from a
Medicare Administrative
Contractor. Your MAC This is a big MAC Your MAC is sort of a like a
personal trainer. He or she will help you to
identify and correct claims
mistakes. You’ll then have 45 days to
apply what you’ve learned as
you file new claims The goal is to help you get it
right Now, Mac and I are going to
walk you through the process First, how do you know if you’re
selected for a TPE audit? You get a letter from a MAC a Medicare Administrative
Contractor It will look something like this After you receive the letter, the MAC will review a sample of
your claims and accompanying
records if there are problems then we do the one-on-one
education session Then you get 45 days to clean
things up If you improve sufficiently If you improve sufficiently
you’ll get your claims approved
and unless you change your
billing practices significantly you’ll get your claims approved
and unless you change your
billing practices significantly you won’t be reviewed again for
that item or service for at
least one year If you don’t improve enough
you go through the process again You can go through up to three
rounds of reviews and education before your MAC contacts CMS
for next steps Most of the providers who have
been through Targeted, Probe,
and educate so far have improved and not been
referred to CMS. That’s more honest mistakes
avoided and more honest providers
getting paid without problems And for those not being honest well well, the outcome is not so
good. So this is it in a nutshell Providers with high denial rates
or unusual billing practices get
identified issues are pinpointed and
feedback is shared with the
provider Then there are up to three
rounds of education sessions
and reviews. If providers sufficiently
improve and make no significant changes
in their billing practices they will not go through another
TPE audit for that item or
service for at least one year hey thanks for your help and thanks for watching so who is your financial person I’ve got this brother in-law