First Coast has initiated TPE under the direction of the CMS to reduce provider burden, claim denials, and appeals through one-on-one education.

The TPE process can consist of three rounds of prepayment and/or post-payment probe reviews with one-on-one education. This will allow First Coast the opportunity to educate providers before, during and after the probe.

Providers will receive initial notification education before additional documentation requests (ADRs) are sent out to help them understand the documentation requirements for the procedure code involved with the review and how to properly submit the documentation. Education will continue throughout the review process allowing for additional documentation to be requested if resolvable errors are found while completing the review. At the end of the probe the nurse reviewer will offer an educational teleconference to provide detailed one-on-one education on errors found during the probe.

Providers with a review resulting in a zero or low error rate will not move on to the next round of TPE. Providers with a review resulting in a high error rate may move on to the next round and will receive additional education.

There is a minimum of a 45-day break between each TPE round; giving providers time to implement any changes they feel are necessary after education.

For more information, please visit the CMS TPE page of their website.