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Round timing is provider-specific under new initiative.<\/em><\/strong><\/span><\/p>\n Getting a clear picture of the Targeted Probe & Educate program\u2019s impact on the home care industry is complicated by \u201cround\u201d confusion.<\/p>\n Old way:<\/span>\u00a0<\/strong>Under the Probe & Educate program, the HHH Medicare Administrative Contractors reviewed five claims from every home health agency nationwide in one time period known as round 1.<\/p>\n Agencies that had zero or 1 claim with problems were then done with the program, while HHAs with two or more claims denied were kept on for round 2. The program ended before reaching round 3.<\/p>\n New way:<\/span>\u00a0<\/strong>Under TPE, MAC reviewers target specific providers, selecting \u201cclaims for items\/services that pose the greatest financial risk to the Medicare trust fund and\/or those that have a high national error rate,\u201d the\u00a0Centers for Medicare & Medicaid Services\u00a0<\/strong>says. TPE reviews 20 to 40 claims per item or service, per round, for a total of up to three rounds. \u201cProviders\/suppliers with continued high error rates after three rounds of TPE may be referred to CMS for additional action, which may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action,\u201d CMS says.<\/p>\n Crucial difference:\u00a0<\/strong><\/span>Under P&E, all agencies underwent round 1 in a defined time period. Under TPE, agencies can start on round 1 any time.<\/p>\n A\u00a0Palmetto GBA\u00a0<\/strong>spokesperson elaborates further. \u201cThe TPE \u2018rounds\u2019 are \u2018rolling\u2019 in nature on a per provider basis and do not have a firm start or stop date,\u201d he says. \u201cWhile some providers may indeed be entering round 2, others may just be starting round 1. The TPE edits are provider-specific edits that, because they have a staggered implementation, do not lend themselves to analysis by round,\u201d he explains.<\/p>\n \u201cThere is no monolithic \u2018round 1\u2019 and \u2018round 2\u2019 of all providers, as there was with Probe & Educate,\u201d offers\u00a0Joe Osentoski<\/strong>, reimbursement recovery & appeals director for\u00a0QIRT\u00a0<\/strong>in Troy, Michigan.<\/p>\n Instead, HHAs will need to \u201cconsider a \u2018rolling\u2019 result of agencies who were selected and completed each round (with completion being defined by each MAC).\u201d<\/p>\n Note: TPE information is on the Palmetto GBA website at www.palmettogba.com\/JMB \u2014 click \u201cTopics\u201d on the top navigation bar, then \u201cMedical Review,\u201d then \u201cTargeted Probe and Educate.\u201d<\/em><\/p>\n Source- SuperCoder<\/span><\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Round timing is provider-specific under new initiative. Getting a clear picture of the Targeted Probe & Educate program\u2019s impact on the home care industry is complicated by \u201cround\u201d confusion. Old … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":295,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[11,12,13,14],"class_list":["post-294","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\/294","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=294"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/294\/revisions"}],"predecessor-version":[{"id":296,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/294\/revisions\/296"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/295"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=294"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=294"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}