CMS Says MACs Must Publish Quarterly TPE Results

WASHINGTON—In late September, the Centers for Medicare & Medicaid Services published a Change Request (CR 14616) requiring that the Medicare Administrative Contractors (MACs) post Targeted Probe and Educate (TPE) results on their websites in an effort to keep the provider and supplier communities informed of issues and trends.

The Centers for Medicare & Medicaid Services (CMS) said the change is being made because the home health industry shared that quarterly web postings on MAC websites are a valuable tool to keep the provider and supplier communities informed of issues and trends. This CR attempts to ensure consistency of publication across MACs and is effective starting Monday, Nov. 2. CMS also noted that this CR does not involve any regulatory, statutory or legislative policy.

Requirements of the CR include:

• Each quarter, MACs shall post TPE results with, at a minimum, the top and/or most common reasons for denial (listing the top three, if applicable) per TPE-prioritized problem on their websites.
• If more than three denial reasons for a specific topic would be useful to the supplier community, the MACs must also include those.

LeadingAge, a coalition of 19 partners representing hospitals, physician and clinician practices, post-acute and long-term care providers, home health and hospice agencies and suppliers, celebrated the CR, calling it a “big win” for providers.