REIMBURSEMENT PAGE
By JOSEPH MCTERNAN
Gazing Into the Crystal Ball What does a postpandemic environment look like for O&P?
Editor’s Note—Readers of Reimbursement Page are eligible to earn two CE credits. After reading this column, simply scan the QR code or use the link on page 15 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.
E! QU IZ M EARN
2
BUSINESS CE
CREDITS P.15
14
MAY 2021 | O&P ALMANAC
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F YOU ARE LIKE me, when you first
heard the words “coronavirus” and “COVID-19,” you thought they would cause a short-term inconvenience, and that life would return to normal after a few weeks. More than one year later, the world has changed forever. The COVID-19 public health emergency (PHE) has claimed millions of lives, and each step forward in battling the virus seems to be met with new setbacks, including variants of the virus and surges in infection rates. While the COVID-19 PHE is far from over, the introduction of effective vaccines and continued efforts to reduce the spread of disease have resulted in a little twinkle of light at the end of a long, dark tunnel. This month’s Reimbursement Page takes a look into the future to predict five things that may impact your O&P business in a postpandemic environment.
1
TPE Will Return
CMS acted quickly last spring to ensure that Medicare and Medicaid beneficiaries would continue to have access to effective and appropriate clinical care. Shortly after the PHE declaration, CMS announced significant relaxation of policy requirements to provide flexibility to providers and allow them to focus their efforts on caring for patients rather than chasing documentation. One of these flexibilities was an announcement of the suspension of audits for claims with dates of service during the COVID-19 PHE. This announcement resulted in the suspension of Medicare Target, Probe, and Educate (TPE) audits. The TPE program was implemented in 2018 and transformed the way many Medicare audits were handled. TPE audits are focused in scope and usually examine up to 20 claims at a time on a prepayment basis; they consist of up to three rounds of audit activity with individual, providerbased education after each TPE round. The intent of this process is to address incorrect billing practices and eliminate errors through education. Once a provider shows sufficient improvement in their billing practices, they may be moved out of the TPE process and exempt from future TPE audits for a defined period, usually at least one year. The TPE program has been successful and is very popular with providers, who enjoy fewer audits and increased education. Since TPE audits are always performed on a prepayment basis, they cannot be performed during the PHE. As a result, the TPE program has been formally suspended for the duration of
