New CMS Auditing Initiative

Members & Publications


December 7, 2017

In addition to the proposed resumption of Recovery Audit Contractor (RAC) reviews mentioned in a previous news article, Medicare Administrative Contractors (MACS) will also begin conducting audits for items/services that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate. 

Targeted Probe and Educate (TPE) is a new initiative for MACs to:

  • Limit the number of medical records requested for review
  • Emphasize education and assistance in correcting claims errors.

TPE was begun as a pilot program with one MAC in 3016 and is being expanded to all MACs in late 2017.  It involves the review of 20 to 40 claims per provider/supplier, per item or service, followed by personalized education.  MACs repeat this process of review and education up to three times.

The MACs will select which providers to review by identifying those practices having the highest claim error rates or billing practices that vary significantly from their peers. 

Providers who follow Medicare’s rules before the end of the three rounds will be removed from review for that topic.  Providers who do not will be referred to CMS for stronger corrective action. This new process has the potential to reduce the burden of complying with claims audits if you quickly become compliant with Medicare rules.

Find out more on the CMS TPE webpage at

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.