TPE Audits

Great question. A TPE (Target Probe and Educate) is an educational audit based on the selected codes sanctioned by CMS for the payer to review. TPE can be performed by your local Medicare of DME carrier, depending on which CPT/HCPCS is targeted.

Once you have been selected for a TPE, they will generally ask for 10 charts in a preliminary round. If you pass those (passing =100%) you are exempt from any further TPE for that CPT/HCPCS code for the next year.

However, if you fail this preliminary round, you can pass onto Round one where you are requested to submit an additional 25-40 charts. Because passing for all rounds =100% grade, one wrong piece of documentation can cause you to fail. If you fail round 1, then you can progress to round 2 and failing round 2 you will end up in round 3. Failure in round 3 may result in mandatory pre-payment audit for an expanded set of codes.

Depending on the HCPCS/CPT being targeted, as well as the individual being targeted, the results for TPE vary. And these change from quarter to quarter. Thus, comparing statistics on specific codes from quarter to quarter can be misleading and not necessarily reflective of your practice.

The importance of TPE is that it can provide your practice with the auditor’s insight on where your deficiencies are and help you improve your chart documentation. If you do fail a round, you should inform the auditor that you wish to have an educational appointment and understand your deficiencies.

Acknowledge your deficiencies to the auditor when you have your "educate" meeting. Dedicate yourself to resolving those deficiencies for your next TPE.  Generally, the MAC will order a future TPE in the next quarter, so that they can compare your pre and post TPE documentation to see if you really did learn from your experience.