Medical Review Targeted Probe and Educate Additional Development Requests
Medical Review
NGS Medical Review Department will be performing service specific post-payment reviews for a random selection of claims billed to Medicare Part A and B.
Providers are encouraged to review the Targeted Probe and Educate webpage to learn about what services are being selected, what documentation will be requested and more details on these service specific post-payment reviews.
Targeted Probe and Educate
The purpose of TPE is to reduce costs related to improper payments and appeals, decrease provider burden, and offer one-on-one education in the review process.
NGS supports the TPE process by performing data analysis and MR of records for services billed to the Medicare Trust Fund.
An ADR may be requested in order to obtain records from you. It is important that providers, suppliers and staff members direct the ADR letter to the appropriate person within your group or organization so that a complete response can be sent in a timely manner.
Respond to ADRs within 35-40 days of letter date (CMS allows providers 45 days of the ADR date) and all services must include necessary signatures and credentials of professionals. Medical review documents, medical records, and responses to ADR letters may be sent electronically or by mail.
If you have received any correspondence from NGS MR, please follow the instructions within their letter.
Information about the TPE strategy is located on the Targeted Probe and Educate web page.
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Revised 9/27/2024