{"id":483,"date":"2018-09-17T07:00:14","date_gmt":"2018-09-17T07:00:14","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=483"},"modified":"2018-09-12T15:21:22","modified_gmt":"2018-09-12T15:21:22","slug":"medical-review-try-these-5-tips-to-tpe-success","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2018\/09\/17\/medical-review-try-these-5-tips-to-tpe-success\/","title":{"rendered":"Medical Review: Try These 5 Tips To TPE Success"},"content":{"rendered":"\n<figure class=\"wp-block-image is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/09\/5-Tips-to-TPE-Success.jpg\" alt=\"\" class=\"wp-image-484\" width=\"580\" height=\"229\" srcset=\"https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/09\/5-Tips-to-TPE-Success.jpg 656w, https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/09\/5-Tips-to-TPE-Success-300x119.jpg 300w, https:\/\/advantagehcconsulting.com\/blog\/wp-content\/uploads\/2018\/09\/5-Tips-to-TPE-Success-210x83.jpg 210w\" sizes=\"auto, (max-width: 580px) 100vw, 580px\" \/><\/figure>\n\n\n\n<p><strong><em>Do you know the difference between your charge error rate and your claim error rate?<\/em><\/strong><\/p>\n\n\n\n<p>Whether you want to avoid Targeted Probe &amp; Educate review or get off TPE once you get put on, consider this expert advice:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Know your risk.\u00a0<\/strong>Use tools such as\u00a0<strong>CGS\u2019s\u00a0<\/strong>Comparative Billing Reports to see where you stand in relation to your peers. Instructions for downloading your CBR, which covers stats such as total claims billed, average reimbursement per claim, and denial rates, are at<a href=\"http:\/\/www.cgsmedicare.com\/hhh\/education\/materials\/pdf\/mycgs_comparative_billing_reports_hhh.pdf\">www.cgsmedicare.com\/hhh\/education\/materials\/pdf\/mycgs_comparative_billing_reports_hhh.pdf<\/a>.<\/li><li><strong>Respond.\u00a0<\/strong>When you do receive a TPE documentation request, respond \u2014 urges\u00a0<strong>Joe Osentoski<\/strong>, reimbursement recovery &amp; appeals director for<strong>QIRT\u00a0<\/strong>in Troy, Michigan. You can do so internally or with help from an outside consultant.<\/li><li><strong>Review.\u00a0<\/strong>Check all technical denial areas prior to final billing of a record, Osentoski advises. That includes face-to-face encounter content, certification requirements, and physician estimate requirements.<\/li><li><strong>Educate.\u00a0<\/strong>Use TPE feedback, particularly on the top denial reasons, and MAC educational materials to prep your staff on the TPE target areas.<\/li><li><strong>Learn more.\u00a0<\/strong>Educate yourself about the TPE program. For example: The amount of money denied (Provider Error Rate) is still not reflected in CGS\u2019s released statistics, Osentoski points out. \u201cKnow that this is different than the Review Decisions by State and is the key number that determines the Risk Category for future action,\u201d he says.<\/li><\/ul>\n\n\n\n<p><strong>Tip:\u00a0<\/strong>CGS says it uses PER to make TEP determinations. But\u00a0<strong>Palmetto GBA\u00a0<\/strong>says in a June TPE question-and-answer document that \u201cfor escalation from one round to the next, we\u2019re looking at both claim denial rate and charge denial rate,\u201d which is the same as your PER.<\/p>\n\n\n\n<p><em>Note: See Palmetto\u2019s TPE Q&amp;A at www.palmettogba.com \u2014 click on \u201cJurisdiction M Home Health and Hospice MAC\u201d in the right-side menu; select \u201cMedical Review\u201d from the pull-down \u201cTopics\u201d\u00a0menu in the top bar; click on \u201cTargeted Probe &amp; Educate\u201d; then choose the Q&amp;A document posted June 27.<\/em><\/p>\n\n\n\n<p><em><\/em><\/p>\n\n\n\n<p><strong><a href=\"https:\/\/www.supercoder.com\/coding-newsletters\/my-homecare-week-alert\/medical-review-heres-how-rac-reimbursement-works-and-affects-you-156735-article\"><em>Source- SuperCoder<\/em><\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Do you know the difference between your charge error rate and your claim error rate? Whether you want to avoid Targeted Probe &amp; Educate review or get off TPE once &hellip; <a class=\"readmore\" href=\"https:\/\/advantagehcconsulting.com\/blog\/2018\/09\/17\/medical-review-try-these-5-tips-to-tpe-success\/\">Continue Reading &rarr;<\/a><\/p>\n","protected":false},"author":1,"featured_media":484,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,6,5],"tags":[11,12,13,14],"class_list":["post-483","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance","category-medical-review","category-reimbursement","tag-home-care","tag-hospice","tag-ltc","tag-snf"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/483","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=483"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/483\/revisions"}],"predecessor-version":[{"id":485,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/483\/revisions\/485"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/484"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=483"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=483"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=483"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}