Information and resources on Medicare denials, audits, and appeals. If you have questions about this information, contact firstname.lastname@example.org.
CMS Targeted Probe and Educate Program
The Centers for Medicare and Medicaid Services (CMS) Targeted Probe and Educate (TPE) program provides one-on-one assistance to help providers and suppliers reduce claims denials and appeals. Medicare Administrative Contractors use data analysis to identify specific areas of compliance: (1) providers and suppliers who have high claim error rates or unusual billing practices, and (2) items and services that have high national error rates and are a financial risk to Medicare. Providers whose claims are compliant with Medicare policy won't be chosen for TPE.
Appealing a Denial
When appealing a claim denial, it may be helpful to include a written letter outlining why you disagree with the reason for denial. APTA has created template letters (located below under APTA Template Letters) for members to use in responding to insurance claim denials. Simply insert your individual information where indicated. With your appeal, include any documentation required by policy or needed to substantiate your claims. **Please note that these tools and resources do not constitute legal advice. Consultation with legal counsel may be appropriate to help identify and pursue claims that should be appealed.