Targeted Probe and Educate (TPE): How to Survive All Three Rounds and Avoid Prepayment Review

Why the Correction Window Between Rounds Determines the Outcome, and How TPE Failure Unlocks Extrapolation Authority

Introduction: The Most Forgiving Audit and the Gateway to the Least Forgiving Ones

Targeted Probe and Educate occupies an unusual position in the Medicare program integrity landscape. It is, by design, the most provider-friendly review CMS conducts. The stated purpose is education rather than recovery. The contractor offers to walk you through your errors personally. You get roughly 45 days between rounds specifically so you can fix what was found. A practice that improves exits the process and is generally left alone for at least twelve months.

It is also the doorway to the harshest tools in the program. A practice that fails three rounds is referred to CMS for further action, and the options on that menu include 100 percent prepayment review, extrapolation, and referral to a Recovery Audit Contractor. Any of those outcomes is orders of magnitude worse than the TPE that produced it.

This combination creates a specific failure mode. Because TPE presents as educational, practices tend to treat it as low stakes. Records get pulled and submitted without internal review. The education session gets delegated to whoever is available. The 45-day correction window passes without anyone changing anything, because nothing felt urgent. Then Round 2 produces the same findings as Round 1, and the practice discovers in Round 3 that it has been walking toward a cliff it never saw.

The practices that fare well are not the ones with flawless documentation. They are the ones that recognized in Round 1 that TPE is a time-limited opportunity to fix a problem on favorable terms, and used the structure the program provides.

This guide covers how selection works, what happens in each round, what the correction window is actually for, how the target error rate functions, what referral to CMS means in practice, and the connection between TPE failure and extrapolation authority that most providers never learn until it is too late.

What Targeted Probe and Educate Actually Is

TPE is a medical review program administered by Medicare Administrative Contractors. Rather than reviewing every provider who bills a particular service, MACs focus on specific providers and suppliers whose data suggests a problem with that service.

The mechanics are consistent across MACs. The contractor selects a sample of claims, generally 20 to 40 per round for a specific item or service, requests documentation, reviews it, issues a results letter, and offers individualized education addressing the errors found. The provider then has time to correct course before the next round.

The Design Intent

CMS describes TPE as designed to help providers reduce claim denials and appeals through one-on-one assistance. That framing is accurate as far as it goes. Many TPE errors genuinely are simple and correctable, with a missing physician signature being the canonical example. Education resolves those quickly and permanently.

What the framing understates is the consequence of not improving. The educational posture is real, but it is conditional. It persists only as long as the provider demonstrates progress.

Prepayment or Post-Payment

TPE samples may be drawn on either a prepayment or post-payment basis, and the notification or additional documentation request will indicate which. Most TPE reviews are conducted prepayment, meaning the claims under review are held rather than paid. For a practice with meaningful volume in the targeted service, this produces an immediate cash flow effect that continues throughout the round.

Scope Is Service-Specific

TPE targets a provider for a particular item or service, not the practice’s billing generally. A cardiology practice under TPE for a specific stress testing code is not under review for its office visits. This matters for the response, because it focuses the internal audit and remediation effort on a defined target rather than the entire billing operation.

It also means a practice can be in TPE for more than one service simultaneously, each running its own round sequence.

How Practices Get Selected for TPE

Selection is data-driven. MACs use analysis to identify two categories: providers and suppliers with high claim error rates or unusual billing practices, and items and services with high national error rates that present financial risk to Medicare. CMS has been explicit that providers whose claims are compliant with Medicare policy are not chosen, and that most providers will never experience TPE.

Provider-Level Triggers

• Claim denial rates substantially above those of specialty peers
• Billing practices that vary significantly from peer norms for the same service
• High error rates identified in prior reviews or adjudications
• Billing data suggesting questionable practices in a specific service line
• Sudden changes in volume or coding distribution for a targeted service

Service-Level Triggers

• High national error rates identified through the CERT program
• Findings and recommendations from OIG, GAO, or Recovery Audit Contractor activity
• Service categories representing significant financial risk to the Medicare program
• Historical claims trends showing deterioration in documentation compliance

What Selection Tells You

Because selection is targeted rather than random, a TPE notice carries information. Something in your data placed you outside the expected range for a specific service. The notification letter identifies the service under review and the reason for selection, and that reason is worth reading carefully rather than skimming.

If the letter indicates selection based on denial rate, the practice has a claims-processing or documentation problem that was already producing denials. If selection was based on billing variance from peers, the practice may have a coding pattern issue, or it may have a legitimate clinical explanation that its documentation has not been capturing. Those two situations call for different responses.

The Round Structure: What Happens and When

TPE runs up to three rounds. Each round follows the same sequence.

• Notice of Review. The MAC sends a letter identifying the service under review, the reason for selection, an overview of the process, and contact information.
• Additional documentation request. The contractor requests records for the sampled claims, typically 20 to 40 for the item or service under review. The standard response window is 45 calendar days from the date on the letter.
• Review. The MAC evaluates whether the documentation supports each claim as billed, including medical necessity under the applicable coverage determination. CMS guidance indicates a round should generally not extend beyond approximately six months.
• Results letter. The contractor issues written findings detailing the results of the claim reviews and classifying the error level.
• One-on-one education. Providers with moderate or major error classifications receive an offer for individualized education addressing the specific errors identified. Education may also occur during a round when easily resolved errors surface.
• Correction window. The MAC allows at least 45 days before initiating the next round, specifically so the provider has time to improve.

A provider found compliant at the end of any round exits the process and is generally not reviewed again for at least twelve months, absent significant changes in billing.

Sample Size Variations

While 20 to 40 claims is the standard range, probe samples of different sizes may be approved by CMS on a case-by-case basis. MACs are also directed to choose a claim volume such that a round does not take longer than roughly six months, and to consider closing a round with existing claims where a provider’s billing volume decreases mid-round.

Round 1: Establishing the Baseline

Round 1 establishes what the contractor believes is wrong. Everything that follows is measured against it.

Treat the ADR as an Audit Response, Not a Records Pull

The single most common Round 1 error is submitting documentation without reviewing it first. The practice receives a request for 30 claims, someone prints the encounter notes, and the package goes out. Weeks later the results letter arrives listing errors the practice could have identified itself.

Before submitting, audit each requested claim as the contractor will. Confirm that the documentation supports the service billed, that medical necessity is established under the applicable coverage determination, that signatures are present and legible, that orders and supporting results are included, and that every billed element appears somewhere in the record.

This accomplishes two things. It catches documentation that exists in the chart but was not going to be included in the package, which is a meaningful share of TPE denials. And it tells the practice what the results letter is going to say before it arrives, which converts the next 45 days from reaction into preparation.

The Compliance Standard in Round 1

Round 1 is the strictest round. A provider who achieves full compliance exits immediately. Any errors generally move the provider forward into education and a subsequent round, though the classification of those errors as minor, moderate, or major affects what happens next. Practices with a minor error classification may be treated differently from those with moderate or major findings.

What to Do With the Results Letter

Read the results letter at the claim level rather than the summary level. The summary tells you the error rate. The claim-level detail tells you the pattern, and the pattern is what you have to fix. Twelve denials caused by one provider’s incomplete medical necessity documentation is a fundamentally different problem from twelve denials spread across every provider in the practice.

The One-on-One Education Session

The education session is generally conducted by MAC provider outreach and education staff, usually by teleconference or webinar, and walks through the errors identified in the reviewed claims.

Who Should Attend

The providers whose documentation generated the errors should attend. This sounds obvious and is frequently not done. Practices routinely send the billing manager or compliance officer alone, who then attempts to relay the content secondhand to physicians who did not hear it directly and who may not accept the characterization.

The session should include the responsible providers, the coding staff who handled the claims, and whoever will own the corrective action. If a specific template or workflow produced the errors, include whoever can change it.

Questions Worth Asking

• What specific documentation element was missing on each denied claim? Get to the element, not the category. “Insufficient medical necessity documentation” is not actionable. Knowing that the record did not document a specific required finding is.
• What error rate do we need to reach to exit? CMS has indicated the target error percentage varies based on the service or item under review. Ask directly rather than assuming.
• How is improvement from round to round weighted? Movement between rounds is a factor in whether a provider advances, and understanding how the contractor evaluates it informs where to focus.
• Which coverage determination or policy governs these claims? Get the specific citation so remediation can be built against the actual standard.
• When will Round 2 begin and what will the sample cover? Establishes the working timeline for the correction window.

Document the Session

Take detailed notes and circulate them internally. If the practice later needs to demonstrate that it acted on the education, contemporaneous documentation of what was communicated and what the practice did in response is the evidence.

The 45-Day Correction Window: Your Most Valuable Asset

This is the section that determines outcomes.

The MAC allows at least 45 days between rounds explicitly so the provider has time to improve. It is the only phase of any Medicare audit where the contractor pauses, tells you what is wrong, and gives you a defined period to fix it before looking again. Nothing comparable exists in RAC, UPIC, or SMRC reviews.

Practices that use it well exit at Round 2. Practices that let it pass see Round 3.

A Working Plan for the Window

• Week 1: Diagnose the pattern. Analyze the results letter at the claim level. Determine whether errors cluster by provider, by service subtype, by documentation element, or by template. Identify the root cause rather than the symptom.
• Week 1 to 2: Fix the mechanism. If a template omitted a required element, change the template. If a workflow allowed claims to bill before documentation was complete, change the workflow. If an order was routinely not captured, build the capture step. Fixing the mechanism prevents recurrence in a way that reminding people does not.
• Week 2 to 3: Retrain the responsible providers. Target the specific documentation elements that failed, against the specific coverage determination that governs. General documentation training does not move a TPE error rate.
• Week 3 to 5: Run an internal probe. Pull 10 to 20 recent claims for the same service, billed after the remediation, and audit them against the same standard the MAC applied. This is the verification step, and it is the one practices skip.
• Week 5 to 6: Close remaining gaps and document everything. Correct anything the internal probe surfaced. Assemble a record of what was identified, what was changed, who was trained, and what the internal probe showed.

Why the Internal Probe Matters

Remediation that has not been tested is a hypothesis. A practice that retrains its providers and assumes the problem is solved has no idea whether the claims now being billed would survive review. Round 2 becomes the test, and if the remediation did not work, the practice learns that only after the round is complete and a third round has been triggered.

An internal probe of recent claims answers the question while there is still time to act on the answer. If the probe shows the error persists, the practice has weeks to address it rather than discovering the failure through the contractor.

Claims Billed During the Window

Remember that the claims sampled in Round 2 will be drawn from a period that includes the correction window and after. Remediation implemented on day 40 of a 45-day window affects very few of the claims that will be reviewed. Speed matters, and front-loading the fix into the first two weeks materially increases the share of Round 2 claims that reflect corrected practice.

Round 2: Where Improvement Matters More Than Perfection

Round 2 follows the same mechanics as Round 1: another sample of 20 to 40 claims, another documentation request, another review, another results letter, and if needed, another education session and correction window.

The Standard Shifts

Unlike Round 1, perfect compliance is not required to exit at Round 2. The provider must reach a target error rate, and CMS has indicated that the required percentage varies depending on the service or item under review. This is why asking the educator what the expectation is going into Round 2 is a practical necessity rather than a courtesy question.

Improvement from round to round is itself a significant factor. A provider who moves from a 60 percent error rate to a 20 percent error rate has demonstrated that education worked, which is what the program is designed to produce. A provider whose rate is unchanged has demonstrated the opposite.

The Diagnostic Value of Round 2 Findings

Compare the Round 2 errors against Round 1 at the element level. Three patterns are possible, and each means something different.

• The same errors persist. The remediation did not reach the point of failure. Either the wrong mechanism was fixed, the training did not reach the responsible providers, or the change was implemented too late in the window to affect the sampled claims.
• The original errors resolved but new ones appeared. Often a sign that a template or workflow change introduced a different gap. This is recoverable and typically resolves quickly once identified.
• Errors reduced but not eliminated. The remediation worked and needs to be extended. Determine whether the residual errors come from claims billed before the fix took effect, which would suggest the trajectory is better than the rate indicates.

That last point is worth raising with the contractor. If a meaningful share of Round 2 claims predate the remediation, the practice’s current compliance is better than the round’s error rate suggests, and that context is legitimately relevant to how the contractor evaluates improvement.

Round 3: The Last Exit

Round 3 uses the same process and generally the same target error rate as Round 2. What differs entirely is the consequence of failure.

At the end of Rounds 1 and 2, a provider who does not meet the standard receives more education and another opportunity. At the end of Round 3, a provider who does not meet the standard is referred to CMS for possible further action.

What Should Change in Round 3

If a practice reaches Round 3, the internal approach that produced Rounds 1 and 2 has not worked. Continuing it is not a strategy.

• Bring in external expertise. An independent auditor with no prior involvement in the claims will identify things internal review has repeatedly missed. Two failed rounds is strong evidence that the internal read of the documentation differs from the contractor’s.
• Consider prepayment internal review. Reviewing claims for the targeted service before submission, during the Round 3 period, ensures that the claims entering the sample are ones the practice has already validated.
• Escalate ownership. Round 3 warrants physician leadership attention and a named owner with authority to change clinical documentation practice, not just administrative process.
• Evaluate whether to appeal Round 2 denials. If the practice believes specific denials were wrong, the appeal outcome may be relevant. Denials overturned on appeal reflect on the accuracy of the error rate that drove escalation.
• Engage counsel if extrapolation is a realistic outcome. The exposure at the end of Round 3 may extend well beyond the claims reviewed, and the posture should reflect that.

What Happens After Three Failed Rounds

CMS is explicit that problems failing to improve after three rounds of education sessions will be referred to CMS for next steps, and that these may include 100 percent prepayment review, extrapolation, referral to a Recovery Auditor, or other action.

Each of these deserves to be understood on its own terms.

100 Percent Prepayment Review

Every claim for the affected service is held and reviewed before payment. For a practice with significant volume in that service, this is a sustained cash flow interruption of indefinite duration, layered on top of the administrative burden of producing documentation for every single claim. Practices generally cannot operate through extended full prepayment review without external financing.

Extrapolation

The error rate found in a sample is projected across the universe of comparable claims, converting a finding measured in thousands of dollars into a demand measured in hundreds of thousands or millions. This is addressed in the section that follows and in the companion article in this series.

Referral to a Recovery Auditor

A RAC operating on contingency fee then reviews the provider’s claims, with a three-year look-back available under the baseline documentation request limit. The educational posture is gone entirely at this point.

Other Action

This category includes referral for program integrity investigation, which moves the matter from payment review into the fraud, waste, and abuse framework, with the enforcement exposure that entails.

The Extrapolation Connection Most Providers Miss

This is the most important thing in this article and it is almost never explained to providers going through TPE.

Extrapolation authority in Medicare Parts A and B is limited by statute. Section 1893(f)(3) of the Social Security Act, added by the Medicare Modernization Act, restricts the use of extrapolation to determine overpayment amounts to circumstances where the Secretary determines either that there is a sustained or high level of payment error, or that documented educational intervention has failed to correct the payment error.

The Medicare Program Integrity Manual implements this. A contractor shall use statistical sampling when it has been determined that a sustained or high level of payment error exists, and statistical sampling may be used after documented educational intervention has failed to correct the payment error.

TPE is documented educational intervention.

That is the connection. A practice that goes through three rounds of TPE without correcting its error rate has, in the regulatory framework, participated in a documented educational intervention that failed. That failure independently satisfies one of the two statutory conditions for extrapolation, regardless of whether the error rate reached the threshold that would qualify as high on its own.

Why This Reframes the Correction Window

Understood this way, the 45 days between rounds is not merely an opportunity to avoid another round of paperwork. It is the window in which a practice can prevent the government from acquiring the statutory predicate to project its error rate across three years of billing.

A practice that grasps this in Round 1 allocates resources very differently than one that treats TPE as an administrative nuisance. The cost of a serious remediation effort during the correction window is a fraction of the cost of an extrapolated overpayment demand, and the remediation is the only one of the two the practice controls.

A Related Point on Historical Noncompliance

The Program Integrity Manual also permits contractors to consider a provider’s past noncompliance for the same or similar billing issues, or a historical pattern of noncompliant billing practice. TPE findings become part of that history. A practice that resolves a TPE and later faces an unrelated review has a documented record showing the issue was identified and corrected. A practice that failed three rounds has a documented record showing the opposite.

The Four Errors That Drive Most TPE Denials

Across MACs and specialties, TPE denials concentrate in a small number of categories. Auditing your own claims against these four before Round 1 submission addresses a substantial share of typical findings.

Missing or Invalid Certifying Physician Signature

The most common and most easily corrected error in the entire program. A signature that is absent, illegible, undated, or missing credentials produces a denial on documentation that may otherwise be complete. Where a signature is illegible or was not captured, a properly executed signature attestation is an accepted remedy that adds no clinical content and therefore carries none of the risk of substantive amendment.

Documentation Does Not Support Medical Necessity

The highest-value category and the hardest to fix quickly, because it requires changing what providers write rather than adding a missing element. The failure is typically that the record documents what was done without documenting why it was clinically indicated under the governing coverage determination. Remediation requires identifying the specific criteria in the applicable policy and ensuring the documentation addresses each one.

Encounter Notes Do Not Support All Elements of Eligibility

Common where a service carries specific coverage conditions, such as frequency limits, prior treatment requirements, or clinical thresholds. The service may have been entirely appropriate while the note simply fails to establish that the eligibility conditions were met. This is frequently a template problem rather than a clinical one.

Missing or Incomplete Initial Certifications or Recertifications

Where a service requires certification or periodic recertification, absence of a complete and timely certification is a categorical denial regardless of the clinical documentation quality. This is a workflow failure and is corrected by building the certification capture into the process rather than relying on individual diligence.

A Practical Round-by-Round Action Plan

On Receipt of the Notice of Review

• Identify the specific service under review and the stated reason for selection
• Determine whether the sample is prepayment or post-payment and assess the cash flow implication
• Calendar the documentation deadline from the letter date, not the receipt date
• Assign a named owner with authority to change documentation practice, not just to collect records
• Pull the governing coverage determination for the service and distribute it to the responsible providers

Before Submitting Any Round

• Audit every requested claim against the coverage determination as the contractor will
• Confirm signatures are present, legible, dated, and credentialed, and prepare attestations where needed
• Verify orders, results, certifications, and supporting records are included, including any held by outside entities
• Organize the package claim by claim with a consistent internal structure and an index
• Retain a complete copy exactly as submitted, with proof of timely transmission

On Receipt of Each Results Letter

• Analyze findings at the claim and element level, not the summary level
• Determine whether errors cluster by provider, service subtype, documentation element, or template
• Schedule the education session with the responsible providers present
• Establish the target error rate and the contractor’s improvement expectations

During Every Correction Window

• Fix the mechanism, not just the behavior, in the first two weeks
• Retrain the specific providers on the specific elements against the specific policy
• Run an internal probe of recent post-remediation claims to verify the fix worked
• Document what was identified, what changed, who was trained, and what the probe showed

Special Case: The Low Biller Probe and Educate Program

Traditional TPE requires enough claim volume to support a 20 to 40 claim sample, which excludes lower-volume providers who might nonetheless benefit from education. CMS addressed this with the Low Biller Probe and Educate Program, a nationwide initiative that reviews fewer than 20 claims per round, for up to three rounds.

The program follows the same structure and philosophy as traditional TPE, focusing on providers and suppliers who present risk to the Medicare program based on data analysis and who could benefit from education. Education is provided consistent with the traditional program.

The practical implication for small practices is that low Medicare volume does not confer immunity from probe review. The same preparation, correction window discipline, and remediation approach applies, with the added consideration that a very small sample makes each individual claim proportionally more significant to the error rate.

Exiting TPE and What Comes After

A provider found compliant at the end of any round is removed from the TPE process for that service and generally will not be reviewed again for at least twelve months, absent significant changes in billing practice.

Do Not Let the Remediation Decay

The twelve-month reprieve is conditional on the practice’s billing remaining compliant. Practices that exit TPE and then allow the corrected practice to erode, through provider turnover, template changes, or simple drift, frequently reappear in a subsequent round.

Build the corrected documentation standard into onboarding for new providers, into the template governance process, and into periodic internal auditing. The service that drew a TPE is by definition a service where your practice was an outlier, which makes it a reasonable candidate for ongoing monitoring regardless of TPE status.

Preserve the Record

Retain documentation of the TPE, the findings, the education received, the corrective action taken, and the results. This record demonstrates that the practice identified a compliance issue and remediated it, which is materially relevant if the same or a similar issue is raised in a future review, and which bears directly on the knowledge element in any subsequent False Claims Act analysis.

How DoctorsManagement Helps Practices Exit TPE Early

DoctorsManagement has guided practices through TPE across specialties and MAC jurisdictions. Our involvement is most valuable in Round 1 and during the first correction window, because that is where the outcome is actually determined.

Our auditors hold both the Certified Professional Coder and Certified Professional Medical Auditor credentials and receive ongoing training through NAMAS, our education division. When we review your claims, we review them the way the contractor will.

Our TPE support services include:

• Pre-Submission Claim Audit: Independent review of every requested claim against the governing coverage determination, identifying missing documentation that exists in the chart and forecasting the contractor’s findings before submission
• Response Package Preparation: Assembly of a complete, organized, indexed submission, including signature attestations and supporting records from outside entities
• Results Letter Analysis: Root-cause analysis of findings at the element level, distinguishing provider-specific, template-driven, and workflow-driven error patterns
• Correction Window Remediation: Template and workflow correction, targeted provider training against the specific policy criteria, and internal probe auditing to verify the remediation before the next round begins
• Provider and Staff Training: Documentation education delivered by credentialed auditors using the practice’s own denied claims as the teaching material
• Escalation Defense: Where TPE has progressed to Round 3 or referral, appeal representation, extrapolation defense with statistical and economic expertise, and coordination with counsel

If your practice has received a TPE notice, contact DoctorsManagement at www.doctorsmanagement.com/audit-appeal-defense or call (800) 635-4040. The correction window is a fixed asset that depletes daily.

Frequently Asked Questions

What is Targeted Probe and Educate?

TPE is a Medicare Administrative Contractor medical review program that combines small claim samples with one-on-one education. MACs use data analysis to select providers with high claim error rates or unusual billing practices, and items or services with high national error rates. Each round reviews 20 to 40 claims for a specific service, followed by a results letter, individualized education, and at least 45 days to improve before the next round.

How many claims are reviewed in each TPE round?

Typically 20 to 40 claims per provider per item or service, though CMS may approve different sample sizes case by case. The Low Biller Probe and Educate Program reviews fewer than 20 claims per round for lower-volume providers. MACs are directed to select a volume that keeps a round to approximately six months.

How long do I have between TPE rounds?

At least 45 days, allowed specifically so the provider has time to improve. This window is the most valuable asset in the process. Remediation implemented in the first two weeks affects more of the claims that will be sampled in the next round than remediation implemented late in the window.

What error rate do I need to reach to exit TPE?

Round 1 generally requires full compliance to exit immediately. For Rounds 2 and 3, CMS has indicated the required target error percentage varies based on the service or item under review, and improvement from round to round is a significant factor. Ask the MAC educator directly what the expectation is rather than assuming, since the answer is service-specific.

What happens if I fail all three rounds of TPE?

The MAC refers the provider to CMS for possible further action, which may include 100 percent prepayment review, extrapolation, referral to a Recovery Auditor, or other action including program integrity referral. Each of these is substantially more damaging than the TPE itself.

Can TPE lead to extrapolation?

Yes, and this is the connection most providers miss. Section 1893(f)(3) of the Social Security Act limits Part A and Part B extrapolation to situations where there is a sustained or high level of payment error, or where documented educational intervention has failed to correct the payment error. TPE is documented educational intervention. Failing three rounds independently satisfies one of the two statutory conditions for extrapolation.

Is TPE prepayment or post-payment?

Samples may be drawn on either basis, and the notification or documentation request will specify which. Most TPE reviews are prepayment, meaning the claims under review are held rather than paid, which creates an immediate cash flow effect for practices with meaningful volume in the targeted service.

Who should attend the one-on-one education session?

The providers whose documentation generated the errors, the coding staff who handled the claims, and whoever will own the corrective action, including anyone with authority to change the affected template or workflow. Sending an administrator alone to relay the content secondhand is a common and costly shortcut.

How long am I left alone after exiting TPE?

A provider found compliant is generally not reviewed again for that service for at least twelve months, absent significant changes in billing practice. That reprieve depends on the corrected practice holding, so the remediation should be built into onboarding, template governance, and ongoing internal auditing rather than treated as a one-time fix.

How can DoctorsManagement help with a TPE audit?

DoctorsManagement provides pre-submission claim auditing, response package preparation, results letter root-cause analysis, correction window remediation with internal probe verification, targeted provider training, and escalation defense including extrapolation challenge. Contact us at www.doctorsmanagement.com/contact-us or call (800) 635-4040.

External Resources and References

• CMS Targeted Probe and Educate (TPE) Program Page
• CMS Targeted Probe and Educate Questions and Answers
• CMS TPE Process Flow Chart
• Medicare Program Integrity Manual, Chapter 8
• CMS Manual Transmittal on Statistical Sampling (R11797PI)
• CMS Medicare Overpayments Fact Sheet (MLN006379)
• CMS Regulations and Guidance
• OIG Work Plan
• DoctorsManagement Audit Appeal and Defense
• DoctorsManagement Coding and Documentation Review
• DoctorsManagement Compliance Training for Physicians and Staff
• DoctorsManagement Total Compliance Solution

Contact Us

This article is provided for informational and educational purposes only and does not constitute legal advice. TPE procedures, sample sizes, target error rates, and escalation criteria are subject to change and vary by MAC and by the service under review. Practices in TPE should consult qualified compliance professionals regarding their specific circumstances. DoctorsManagement is available to provide TPE response and remediation support at any round.

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