Results of one Medicare administrative contractor’s Target Probe & Educate (TPE) process shows some familiar challenges for agencies struggling with documentation.
Palmetto GBA released the results of the TPE process from April to June of 2022. Results varied across more than a dozen states included in the review, with only one of 80 claims denied in New Mexico while 26 of 80 claims, or one out of every three claims, were denied in Oklahoma.
The top 5 reasons overall for denials were:
- Face-to-face encounter requirement not met: 94
- The documentation submitted was insufficient to support that the skilled nurse services billed was/were reasonable and necessary: 51
- No plan of care or certification: 47
- No physician’s order for services or more than ordered: 24
- Dependent services denied — qualifying service denied medically or technically: 21