The Centers for Medicare & Medicaid service (CMS) has updated its Medicare fraud and improper payment audit process to target providers and suppliers who frequently demonstrate high medical billing error rates. The new Targeted Probe and Educate method replaces a medical review strategy that included broad medical billing investigations and provider education.
CMS decided to replace the original Probe and Educate method for a more targeted approach, according to its website. Under the Targeted Probe and Education method, Medicare Administrative Contractors (MACs) will review 20 to 40 claims from Medicare providers and conduct one-on-one, personalized education sessions to address medical billing errors found in the reviewed claims.
CMS launched the Probe and Educate initiative in 2014 that selected a limited number of claims from each Medicare provider for review. MACs assessed the claims for noncompliance and educated providers on proper medical billing and Medicare fraud prevention strategies. Providers who demonstrated higher medical billing error rates than their peers received more training from MACs.
Based on the successes of a Targeted Probe and Educate pilot in four MAC jurisdictions from June 2016 to July 2017, CMS elected to expand the initiative to all Medicare providers. CMS will introduce the process to all MAC jurisdictions later in 2017, according to the website.