Palmetto GBA, Medicare Administrative Contractor for the states of Alabama, Georgia and Tennessee, has published their Part A and Part B Targeted Probe and Educate Active Medical Review List. If you are a non-private practice, Palmetto GBA is looking at CPT codes 97110, 97112 and 97140 when billed with and without a KX modifier. If you are a private practice, Palmetto GBA is looking at CPT codes 97110, 97112, 97140 and 97530 when billed without the KX modifier. Click HERE to view the complete list.

First Coast Service Options (FCSO), Medicare Administrative Contractor for the state of Florida, currently has 2 different Targeted Probe & Educate (TPE) reviews in process. If you are an outpatient rehabilitation facility (ORF), FCSO currently has a TPE in process looking at CPT codes 97110, 97112, and 97140. If you are a private practice, FCSO currently has a TPE in process looking at CPT code 97112. Click HERE for further details.

First Coast Service Options, Inc. has published their Targeted Probe and Educate topics for the state of Florida. No surprise that 97110 is one of the topics for facilities (SNF, Rehab Agency and Hospital Outpatient Therapy Departments) and 97112 is one of the topics for private practices. Click HERE for the details.

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.

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