Medical Billers and Coders

  The Centers for Medicare & Medicaid Services (CMS) is resuming the Targeted Probe & Educate (TPE) audit, effective September 1, 2021. Based on data analysis of claims payment, CMS will identify areas with the greatest risk of inappropriate program payment. 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. Let’s focus on the basics of Medicare TPE audits. A TPE audit is a close examination of the billing practices that a healthcare provider uses for its Medicare claims. The provider’s Medicare Administrative Contractor (MAC) conducts the auditing process. If unusual billing practices, mistakes, or discrepancies are found between the Medicare claims and the healthcare services that were provided to the patient, the MAC will help the provider fix the problems and show them how to avoid making them in the future. Even though the MAC conducts the audit, the  Centers for Medicare an

Critical care is the direct delivery by a physician(s) of medical care for a critically sick or injured patient.  The care of such patients involves decision making of high complexity to assess, manipulate, and uphold central nervous system failure, circulatory failure, stun like conditions, renal, hepatic, metabolic, or respiratory failure, postoperative complications, overwhelming infection, or other fundamental system capacities to treat single or multiple indispensable organ system failure or to prevent further deterioration.  It may require extensive interpretation of multiple databases and the use of advanced technology to manage the patient.  Critical care services include yet are not limited to, the treatment or prevention of further deterioration of the central nervous system failure, circulatory failure, stun-like conditions, renal, hepatic, metabolic, or respiratory failure, postoperative complications, or overwhelming infection.  To reliably and consistently determine that