TPE Audits and Denials: Why Getting It Right the First Time Matters
Targeted Probe and Educate (TPE) audits are designed to identify billing and documentation vulnerabilities, but for providers, they often feel overwhelming. Tight timelines, complex documentation requirements, and the financial risk tied to unfavorable determinations make TPE audits one of the most high-stakes reviews organizations face. What many providers underestimate is what happens after a failed TPE review. An unfavorable outcome does not just result in denials. It in
Feb 113 min read
January 2026 Five-Star Report Update: What Changed and Why It Matters
CMS updated Care Compare on February 5, 2026, to reflect values for the new hybrid antipsychotic quality measure. However, when reviewing the January 2026 Five-Star Preview Reports today compared to when they were first released, the data presentation and scoring methodology appear to have changed. What the Five-Star Report Initially Showed When CMS first released the Five-Star Preview Reports on January 21, 2026, the new hybrid antipsychotic quality measure displayed “N/A” v
Feb 62 min read
Best Practices for Preparing for Medicare TPE Audits with Confidence
Targeted Probe and Educate (TPE) audits can be one of the most stressful experiences for post-acute providers. Tight timelines, extensive documentation requests, and the risk of payment denial place significant pressure on clinical, MDS, and billing teams. The good news is that TPE audits are highly manageable when organizations take a proactive, organized approach to information gathering and submission. Below are some best practices for preparing documentation, avoiding co
Feb 23 min read
CMS Updates Facility and Resident Level Quality Measure Reports with New “MDS Hybrid Measure”
Starting January 2026, CMS updates the long-stay antipsychotic QM with a new MDS Hybrid Measure. Understand the changes, triggers, exclusions, and reporting impact.
Jan 22 min read
Strengthening Medication Compliance in Assisted Living
Medication compliance in assisted living impacts safety, quality, and survey outcomes. Discover Ohio regulations, compliance risks, and proven strategies for safer medication management.
Dec 15, 20252 min read
New MDS 3.0 RAI Manual 2025 (v1.20.1) Released - What SNFs Need to Know
The Centers for Medicare & Medicaid Services (CMS) has posted on Friday August 29, 2025, the Final MDS 3.0 Resident Assessment Instrument (RAI) User’s Manual version 1.20.1 , which will take effect on October 1, 2025. This update marks a significant shift in assessment items, Quality Measures, and overall coding requirements for Skilled Nursing Facilities. CMS has also published the final MDS 3.0 Item Sets v1.20.1v3 and their corresponding Item Matrix, also scheduled to go l
Sep 3, 20253 min read
