In an October Medicare Minute Video, CGS Chief Medical Officer Dr. Robert Hoover clarified that MACs will exclude respiratory, CGM, and infusion claims from prepayment audits under the Targeted Probe and Educate (TPE) program.
CMS gave the MACs the greenlight to resume TPE audits in August, but the MACs are excluding certain items covered by CMS rules suspending certain coverage requirements during the COVID-19 public health emergency. Those exceptions include:
Exclusion of these products is temporary.
The MACs are already sending out development letters for other items, and suppliers should assemble strong documentation packages for the initial claims requested under any new TPE audit. A perfect score on the first ten records excludes the supplier from additional inquiries on the audited product; errors will result in further development of a larger sample.
SOURCE LINKS
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-08-12-mlnc
https://cgsmedicare.com/jc/pubs/news/2021/08/cope23173.html
https://cgsmedicare.com/jc/education/video/mm_tpe_transcript_2021.pdf
https://cgsmedicare.com/jc/education/video/vid_tper.html
CMS gave the MACs the greenlight to resume TPE audits in August, but the MACs are excluding certain items covered by CMS rules suspending certain coverage requirements during the COVID-19 public health emergency. Those exceptions include:
- Oxygen.
- Nebulizers.
- CPAPs.
- Oral appliances.
- Respiratory assist devices.
- Ventilators.
- Mechanical in-exsufflation devices.
- High frequency chest wall oscillation devices.
- Intrapulmonary percussive ventilators.
- Respiratory suction pumps.
- Continuous glucose monitors.
- External infusion pumps.
Exclusion of these products is temporary.
The MACs are already sending out development letters for other items, and suppliers should assemble strong documentation packages for the initial claims requested under any new TPE audit. A perfect score on the first ten records excludes the supplier from additional inquiries on the audited product; errors will result in further development of a larger sample.
SOURCE LINKS
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-08-12-mlnc
https://cgsmedicare.com/jc/pubs/news/2021/08/cope23173.html
https://cgsmedicare.com/jc/education/video/mm_tpe_transcript_2021.pdf
https://cgsmedicare.com/jc/education/video/vid_tper.html
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