What Organizations Should Expect Regarding TPE Audits for Medicare Part A
The Centers for Medicare & Medicaid Services (CMS) launched the SNF 5-Claim Probe and Educate (SPE) in 2023 in response to a 15.1% improper payment rate under the Patient-Driven Payment Model (PDPM), identified in 2022 (2023). The probe was meant to audit five PDPM claims per skilled nursing facility (SNF) and offer education based on the findings. At the time of the roll out, CMS projected that providers with error rates under 20% could request…
