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Targeted probe and educate

News
more Targeted probe and educate (TPE) reviews have been temporarily postponed
TPE reviews have been temporarily postponed due to the public health emergency (PHE) declared as a result of the 2019 novel coronavirus (COVID-19). We encourage providers to focus on patient care and defer discussions related to these reviews after the PHE. First Coast will reach out to providers after the pandemic to offer education based upon prior reviews. In the event providers would like to receive education during this time, we are prepared to provide educational sessions. Please feel free to reach out to the nurse assigned to your case to arrange an educational call. View more information regarding COVID-19
Overview
CMS has authorized First Coast to conduct reviews utilizing a targeted probe and educate (TPE) review process.
TPE is one process that a Medicare Administrative Contractor (MAC) can utilize when providers are selected by Medical Review. The TPE review process may include up to three rounds of a prepayment or post-payment probe review with education. If there are continued high denials after the first three rounds of reviews, First Coast Service Options will refer the provider and results to the Centers for Medicare & Medicaid Services (CMS).
Review topics
Resources
more TPE video – learn more about the TPE process external link
Medical documentation and checklists
ADR sample letters
Medical record documentation is required to record pertinent facts, findings, and observations about an individual’s health history including past and present illnesses, examinations, tests, treatments, and outcomes. Find tips, tools and resources for the documentation of clinical services provided to Medicare patients. Use the checklists to ensure you have met medical documentation requirements based on specific services.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.