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Expert: Crucial data missing from TPE report.<\/em><\/strong><\/span><\/p>\n One HHH Medicare Administrative Contractor\u2019s TPE results report provides some valuable data that will help agencies navigate TPE medical review.<\/p>\n For example:\u00a0<\/strong><\/span>For the first time, MAC\u00a0CGS\u00a0<\/strong>gives its cut-off for the \u201cminor\u201d risk category that will allow providers to get off Targeted Probe & Educate review \u2014 a 25 percent \u201cerror rate.\u201d Agencies in the \u201cmoderate\u201d 26-50 percent error rate category and the \u201csignificant\u201d 51-100 percent error rate category will stay on TPE, the article indicates. It also says how many agencies from TPE\u2019s first six months are in each category \u2014 20 percent minor, 33 percent moderate, and 47 percent significant.<\/p>\n These categories are somewhat different than the original P&E program, where errors on zero to one claims (up to 20 percent) allowed providers to get off review.<\/p>\n However:\u00a0<\/strong>A direct comparison isn\u2019t necessarily available. It appears that the risk categories for TPE are based on the \u201cProvider Error Rate,\u201d according to\u00a0Centers for Medicare & Medicaid Services\u00a0<\/strong>materials about the program.<\/p>\n The PER is \u201cthe percentage of the total amount of money billed in that group of TPE ADRs that was denied,\u201d explains consultant\u00a0Joe Osentoski\u00a0<\/strong>with\u00a0QIRT\u00a0<\/strong>in Troy, Michigan. It\u2019s essentially the same as the Charge Denial Rate, Osentoski says.<\/p>\n \u201cIt\u2019s the amount of money denied that is key to getting off the review,\u201d Osentoski stresses. \u201cThat shows the true trend of provider compliance or noncompliance.\u201d<\/p>\n In contrast, \u201cmany claims can partially deny for issues, so I have always found that as a lesser indicator of review outcome,\u201d Osentoski says.<\/p>\n However, while CGS furnishes the percentage of agencies that were found \u201ccomplaint\u201d and \u201cnon-compliant\u201d under TPE round 1, a state-by-state bar graph of denials, the percentage of agencies in each risk category, the percentage of reasons for denials, and the error rate category definitions, it does not provide PER or CDR statistics, Osentoski emphasizes.<\/p>\n \u201cThe percentage of claims with denials \u2026 may affect the number of appeals to be filed, [but] it does not have a direct effect on whether review activity continues or the other actions are initiated,\u201d Osentoski points out.<\/p>\n Keep in mind:\u00a0<\/strong><\/span>A direct comparison is probably not going to be available even between MACs conducting TPE either, Osentoski expects.<\/p>\n \u201cEach MAC has a different Charge Denial Rate percentage that will get the agency another round of reviews,\u201d he relates. \u201cSo even when comparing the percentage of agencies proceeding to Round 2 of a TPE, or percentage of claims denied in any state, or what it means have a Minor, Moderate, or Significant risk \u2014 these all vary from MAC to MAC and I do not believe will afford much meaningful comparative data.\u201d<\/p>\n Source- SuperCoder<\/span><\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Expert: Crucial data missing from TPE report. One HHH Medicare Administrative Contractor\u2019s TPE results report provides some valuable data that will help agencies navigate TPE medical review. For example:\u00a0For the … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":274,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[11,12,13,14],"class_list":["post-273","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-review","tag-home-care","tag-hospice","tag-ltc","tag-snf"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/273","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=273"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/273\/revisions"}],"predecessor-version":[{"id":275,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/273\/revisions\/275"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/274"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=273"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=273"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=273"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}