{"id":480,"date":"2018-09-14T07:00:54","date_gmt":"2018-09-14T07:00:54","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=480"},"modified":"2018-09-17T14:50:32","modified_gmt":"2018-09-17T14:50:32","slug":"targeted-probe-educate-its-getting-worse-91-bomb-tpe-so-far","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2018\/09\/14\/targeted-probe-educate-its-getting-worse-91-bomb-tpe-so-far\/","title":{"rendered":"Targeted Probe & Educate: It’s Getting Worse: 91% Bomb TPE So Far"},"content":{"rendered":"\n
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One MAC releases new stats about the medical review program.<\/em><\/strong><\/p>\n\n\n\n

As Targeted Probe & Educate rolls on, home health agencies are increasingly getting flattened by the new medical review program. So show new TPE results from HHH Medicare Administrative Contractor\u00a0CGS<\/strong>.<\/p>\n\n\n\n

Of the 57 TPE home health probes CGS completed as of June 30, only five resulted in compliant HHAs, the MAC reports in a TPE update posted to its website Sept. 4. That\u2019s a mere 9 percent.<\/p>\n\n\n\n

That leaves 52 HHAs \u2014 91 percent \u2014 that CGS found non-compliant and that advanced to Round 2 of TPE. That statistic is \u201cpretty staggering,\u201d notes reimbursement expert\u00a0M. Aaron Little\u00a0<\/strong>with\u00a0BKD\u00a0<\/strong>in Springfield, Missouri.<\/p>\n\n\n\n

That compares to a slightly-less-whopping 80 percent non-compliant figure CGS released in its last TPE update, which calculated statistics through March 31.<\/p>\n\n\n\n

In contrast:\u00a0<\/strong>HHH MAC\u00a0Palmetto GBA\u00a0<\/strong>didn\u2019t release figures on how many agencies advanced to round 2, but it did note it denied 30.7 percent of claims it reviewed as of late May. And Palmetto said that 217 of the 2,131 HHAs targeted under TPE had completed round 1 of the program as of May 23.\u00a0National Government Services\u00a0<\/strong>hasn\u2019t released TPE stats.<\/p>\n\n\n\n

CGS\u2019s completed, Round 1 numbers may not be as high as Palmetto\u2019s, but at least the 57 probes \u201cgives a workable number to draw some conclusions,\u201d notes\u00a0Joe Osentoski\u00a0<\/strong>with\u00a0QIRT\u00a0<\/strong>in Troy, Michigan.<\/p>\n\n\n\n

Both Little and Osentoski report that many more TPE round 1 probes continue in process.<\/p>\n\n\n\n

Agencies Head Toward ZPIC\/UPIC Scrutiny<\/strong><\/p>\n\n\n\n

The outcome for HHAs that perform poorly is dire, Little points out.<\/p>\n\n\n\n

\u201cProviders\/suppliers with continued high error rates after three rounds of TPE may be referred to [the\u00a0Centers for Medicare & Medicaid Services<\/strong>] for additional action, which may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action,\u201d CMS says on its TPE website.<\/p>\n\n\n\n

Flunking three rounds of TPE is most likely to result in \u201ca referral to the ZPIC\/UPIC, and that will not end well,\u201d Little warns.<\/p>\n\n\n\n

Other TEP statistics CGS released include the top five denial reasons (see related box, p. 259<\/em>), state-by-state denial statistics, and how many agencies are in the \u201cminor,\u201d \u201cmoderate,\u201d and \u201csignificant\u201d risk categories.<\/p>\n\n\n\n

Highlight #1:\u00a0<\/strong>Washington state saw the highest denial rate with all TPE-reviewed claims fully denied from April 1 to June 30, CGS reports. Utah had the best approval rate.<\/p>\n\n\n\n

Highlight #2:\u00a0<\/strong>Five percent of HHAs under TPE landed in the \u201cminor\u201d risk category, comprising an end-of-round provider error rate of 0 to 25 percent. In contrast, 28 percent were in the \u201cmoderate\u201d category of 26 to 50 percent PER and 67 percent were in the \u201csignificant\u201d category with a PER of 51 percent or higher, CGS reports.<\/p>\n\n\n\n

HHAs that fall into the moderate or significant risk categories receive individual education from CGS, the MAC reminds.<\/p>\n\n\n\n

Note: CGS\u2019s TPE update is at\u00a0www.cgsmedicare.com\/hhh\/pubs\/news\/2018\/0918\/cope8993.html<\/a>.<\/em><\/p>\n\n\n\n

Source- SuperCoder<\/em><\/a><\/strong><\/p>\n\n\n\n

<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

One MAC releases new stats about the medical review program. As Targeted Probe & Educate rolls on, home health agencies are increasingly getting flattened by the new medical review program. … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":481,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,6],"tags":[11,12,13,14],"class_list":["post-480","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance","category-medical-review","tag-home-care","tag-hospice","tag-ltc","tag-snf"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/480","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=480"}],"version-history":[{"count":3,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/480\/revisions"}],"predecessor-version":[{"id":491,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/480\/revisions\/491"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/481"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=480"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=480"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=480"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}