Targeted Probe and Educate

When Medicare Claims are submitted accurately, everyone benefits.

CMS's Targeted Probe and Educate (TPE) program is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.

The goal: to help you quickly improve. Medicare Administrative Contractors (MACs) work with you, in person, to identify errors and help you correct them. Many common errors are simple – such as a missing physician's signature – and are easily corrected.

Most providers will never need TPE.

TPE is intended to increase accuracy in very specific areas.
MACs use data analysis to identify:

• providers and suppliers who have high claim error rates or unusual billing practices, and
• items and services that have high national error rates and are a financial risk to Medicare.

Providers whose claims are compliant with Medicare policy won't be chosen for TPE.

What are some common claim errors?

How does it work?

*MACs may conduct additional review if significant changes in provider billing are detected

What if my accuracy still doesn't improve?

This should not be a concern for most providers. The majority that have participated in the TPE process increased the accuracy of their claims. However, any problems that fail to improve after 3 rounds of education sessions will be referred to CMS for next steps. These may include 100 percent prepay review, extrapolation, referral to a Recovery Auditor, or other action.

Learn More About the TPE Program

View, print or share information on the new TPE program with this simple one-pager (PDF).

For further details and information about the TPE program, check out this list of TPE Q&As (PDF).