First Coast will select topics for review based on current data analysis; the most egregious providers identified during the data analysis will be selected for TPE to validate the services billed to Medicare. The procedures are outlined in CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 2.

First Coast will notify providers who have been selected for review with an initial notification letter which will include the topic being reviewed, the reasons for selection which will be supported by data analysis, and the process of review. The nurse reviewer will also call the provider to establish a contact person, introduce their self and provide initial education and information. First Coast will attempt to call one to two times for introduction.