CMS tweaks TPE program

Tuesday, January 8, 2019

WASHINGTON – CMS on Dec. 31 implemented the “TPE 10-Claim Preview Pilot” to help reduce the burden for compliant DME providers, AAHomecare reports.

Per the pilot, the MACs may select 10 claims for review under Round 1, and if a provider is found to be compliant for a service/item, the NPI associated with those 10 claims will be exempt from reviews for about one year for that service/item. If errors are detected, a provider will go through the usual TPE process.

AAHomecare says information on the pilot will be available on CMS’s website soon.

In addition, CMS has also published a new transmittal instructing the MACs to review only services/items with dates of service after one-on-one education for Rounds 2/3, whereas they can review dates of service or dates of submission for Round 1. The MACs must allow 45-56 days between each education intervention to give suppliers time to improve.

The change applies to any new edits for Round 2/3 put in place after the Nov. 28 transmittal.