Current News



CMS to Resume Medical Reviews August 3, 2020

The Centers for Medicare and Medicaid has announced they expect to discontinue exercising enforcement discretion regarding medical reviews beginning on August 3, 2020, regardless of the status of the public health emergency. This includes pre-payment medical reviews conducted by MedicareAdministrative Contractors (MACs) under the Targeted Probe and Educate (TPE) program, and postpayment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). Click HERE to read it straight from CMS. I hope you found this information helpful.

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Recovery Audit Program and Therapy Services

The Medicare Fee-For-Service Recovery Audit Program was initiated in 2009 to reduce improper Medicare payments to suppliers and providers enrolled in the Medicare program. Since its inception, the program has recouped more than $10 billion for the Medicare program. It should be to no ones surprise that therapy services have contributed to the more than $10 billion recouped. Current approved topics pertaining to therapy include: 0138-SNF-Consolidated Billing for Therapies 0124-Part B Therapies in a Hospital Setting 0073-Inpatient Rehabilitation Facility Stays: Meeting Requirements to be Considered Reasonable and Necessary To access the complete list of approved topics, click HERE. Proposed topics

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Targeted Probe and Educate: What Is It?

As many of you have found out the hard way, the Centers for Medicare and Medicaid Services (CMS) implemented a new program called Targeted Probe and Educate (TPE) where the goal of the program is to help providers and suppliers reduce claim denials and appeals through one-on-one education. CMS uses data analysis to identify providers and suppliers who have high claim error rates or unusual billing practices, and items and services that have high national error rates and are a financial risk to Medicare. Upon data analysis, if you are not an outlier in any of the above areas, you

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