Noridian Healthcare Solutions, who serves as the Jurisdiction A and Jurisdiction D Durable Medical Equipment Medicare Administrative Contractor, has released results for its initial audits under the Target, Probe, and Educate (TPE) program in Jurisdiction D. The published results are only for four HCPCS codes selected for the TPE program: L4360, L4361, L4386, and L4387, which all describe walking boot style orthoses.
The results of the TPE audits are encouraging with an improper claim payment rate of 19%. This improper payment rate represents a vast improvement over error rates under the previous audit system which consisted of a probe review followed by a widespread pre-payment review. Improper payment rates under this program ranged from 66% to 100% for walking boot style orthoses.
While the results did not discuss the reason for the significant reduction in the error rate, it is logical to conclude that the improvements are primarily due to the education efforts that are an integral part of the TPE program. The TPE program is designed to provide up to 3 rounds of audits with personalized provider education after each round that is designed to address the specific reasons for claim denial.
The results published by Noridian are certainly encouraging and AOPA will be monitoring the DME MAC websites for additional results from the TPE program.