Healthcare Provider Solutions

Category: Targeted Probe and Educate

NOA, Hospice Medical Review & Sequestration is Back! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: December 27, 2021

This Monday Minute will review the TOP concerns moving into 2022, including the sequestration deductions beginning again. We want to share with you a couple of things on the three most important transitional things as we move into 2022 for both Home Health and Hospice.


Local Coverage Determinations (LCD) (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: October 18, 2021

This Monday Minute reminds home health and hospice about the significance that the LCD can have in the medical review of Medicare charts. We want to remind you about a very important document that the Medicare MACs have developed to help assist agencies in understanding the expectation of your medical record documentation.


Hospice and Home Health PEPPER Reports (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: September 27, 2021

This Monday Minute discusses the impact that PEPPER Reports can have on a Home Care or Hospice agency. We also share the information needed to access your agency’s PEPPER Reports and when these reports are released annually.


Targeted Probe & Educate: Here We Go Again! (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: August 13, 2021

This Minute will take you through a quick recap of the Targeted Probe & Educate framework as the program is being reinstated!


Post Payment Reviews Inside the Public Health Emergency (VIDEO)

By Melinda A. Gaboury, CEO / Posted on: June 7, 2021

This minute covers the news release from CMS concerning, MACs Resume Medical Review on a Post-payment Basis. Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment medical reviews for later dates of service. Make sure to stay tuned!


COVID-19: Interim Final Rule & What It Means for Home Health

By Melinda A. Gaboury, CEO / Posted on: May 14, 2020

There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.


COVID-19: Imperative Home Health and Hospice Updates

By Melinda A. Gaboury, CEO / Posted on: April 1, 2020

This article was last updated on May 7, 2020.

As we are facing the pandemic of the century, home health and hospices are on the frontline of this Public Health Emergency (PHE) along with hospitals, physicians and all other healthcare workers. We at Healthcare Provider Solutions, Inc. would like to take this moment to thank each and every one of you for your true dedication to treating patients and helping the world to be a healthier place. HPS is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success.


Hospice Targeted Probe and Educate – Avoid Claim Denials

By Leslie Heagy, RN, COS-C / Posted on: February 25, 2020

Targeted Probe and Educate (TPE) is continuing to be a problem for Hospice providers with some advancing to rounds 2 and 3 of the audit. This demonstration, which includes hospices receiving 20-40 claim requests for Additional Development Requests (ADR) in each round, have hospices wondering if they are going to be targeted next. In order to avoid advancing to the next round of TPE, the hospice’s calculated error percentage at the end of each round must be less than the percentage set by the MAC.


Targeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons

By Melinda A. Gaboury, CEO / Posted on: May 30, 2019

As long as hospices are carefully documenting the details of each patient’s clinical situation and each patient meets the eligibility requirements for hospice care—these denials are avoidable. Don’t be the hospice that gets technical denials for careless mistakes, like incorrect format of the election statement or completing CTIs with boxed/canned statements that are not specific to the patient.


Top Denial Reasons – Hospice Targeted Probe and Educate

By Leslie Heagy, RN, COS-C / Posted on: September 11, 2018

Targeted Probe and Educate (TPE) is underway for Hospice Agencies. HPS is seeing many ADR denials with agencies moving to round 2 and 3 of TPE from both CGS and NGS.


Targeted Probe and Educate – What We Have Learned So Far

By Melinda A. Gaboury, CEO / Posted on: March 13, 2018

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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Preparing for Hospice Targeted Probe and Educate (TPE)

By Katie Wehri / Posted on: October 31, 2017

As previously reported, the targeted probe and educate (TPE) process is replacing the medical review process used by Medicare Administrative Contractors (MAC).  Each of the three MACs – Palmetto GBA, NGS and CGS – can choose the topics for review under TPE based on existing data analysis procedures.


Targeted Probe and Educate

By Melinda A. Gaboury, CEO / Posted on: September 25, 2017

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.