Targeted probe-and-educate (TPE) reviews by the Medicare Administrative Contractors (MACs) give providers and suppliers three changes to get it right or they’re out. If there are continued high denials after the first three rounds of reviews, the provider is referred to the Centers for Medicare & Medicaid Services (CMS) to determine additional disciplinary action – either extrapolation, referral to the Zone Program Integrity Contractor (ZPIC) or Unified Program Integrity Contractor (UPIC), referral to a Recovery Audit Contractor (RAC), suspension of Medicare payments, or even revocation of Medicare billing privileges.

Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, managing partner of Wachler and Associates. Wachler offers some practical tips and strategic approaches for responding to TPE audits to reduce claim denials.

The broadcast rundown also will include:

• Developing Story: PIM Change: CMS is proposing major changes to the Program Integrity Manual (PIM) – changes that will take effect Jan. 1, 2019. Senior healthcare analyst Frank Cohen, director of analytics and business intelligence for DoctorsManagement, reports on the changes involving sampling and extrapolation.
  
  
• Death by Cyber: RACmonitor investigative reporter and New York attorney Edward Roche suffered a life-threatening medical emergency while in Barcelona, Spain. Roche reports on the one mainstay of America’s hospitals that was missing while he was hospitalized and ultimately experienced a complete recovery.
  
  
• Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.
  
  
• Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest with TPE audits.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

Register now for this important news broadcast coming up at 10 a.m. EST on Monday, Oct. 15.