CMS Announces Resumption of Targeted Probe & Educate Program

With CMS’ 8/12/21 notification of resumption of the Targeted Probe & Educate Program, providers should prepare to receive probe notifications (CMS MLN Connects, 8/12/21, CMS Resumes Targeted Probe & Educate Program). The following tips and strategies will assist with the management of requests.

Take the Following Proactive Steps to Ensure Requests are Received:

  • Verify the Provider Address on File.

  • A frequently reviewed topic involves verifying the provider address on file to ensure receipt of medical review correspondence routed via mail. Medical Review sends Additional Development Request (ADR) letters to request medical records for review. At times, the provider address is no longer current, and the ADR letters are returned as undeliverable.

  • To change the provider address in the Fiscal Intermediary Standard System:

  • Address changes and provider file updates must be reported via the Internet-based Provider Enrollment Chain and Ownership System (PECOS). The preferred method for submitting initial applications or making address changes to your provider file is through Internet-based PECOS.

  • You may also print the electronic versions of the Medicare Enrollment Application CMS-855A form from the Centers for Medicare & Medicaid (CMS) website. There are two address areas on the CMS-855A form: Master and Other. The ADR is automatically generated from the Other Address in FISS. Please ensure the Other Address reflects the address where ADRs should be mailed. Make sure all required fields are completed and the appropriate signature is submitted.

  • Consult the CMS website for education surrounding the TPE program.

  • Review individual facility medical review processes to ensure compliance with provider expectations.

Let's Get to the Point:

Continue to stay informed of available resources for successful management of medical review activity. Please forward questions/inquiries to QRM’s Medical Review team at medreview@qrmhealth.com.