Best Practices for Preparing for Medicare TPE Audits with Confidence
- Jennifer Napier
- Feb 2
- 3 min read
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 common pitfalls, and equipping teams with the tools and processes needed to respond to TPE reviews with confidence.
Understanding the Purpose of a Medicare TPE Audit
TPE audits are designed to ensure Medicare claims are billed correctly and supported by appropriate documentation. Reviewers are evaluating whether the medical record clearly supports the HIPPS code billed, including:
The residents’ need for skilled services
The accuracy of the MDS and underlying assessments
Compliance with Medicare coverage and technical requirements
A successful response is not about overwhelming the reviewer with information. It is about clearly telling the clinical story and making it easy for the reviewer to validate each element of the claim.
Best Practices for Information Gathering
Make the Audit Easy for the Reviewer
Reviewers are working through large volumes of records under tight timelines. Records that are well-organized, clearly labeled, and logically presented allow reviewers to quickly locate the information they need. When documentation is easy to follow, it reduces the likelihood of misinterpretation or oversight.
Use a TPE Checklist
A standardized TPE checklist helps ensure consistency and completeness across all records submitted. A checklist should verify that all required documentation has been gathered and reviewed before submission, reducing the risk of omissions that could lead to denial.
Include a Clear, Concise Cover Letter
A cover letter serves as a roadmap for the reviewer. While not required, it is a best practice that can significantly improve clarity. An effective cover letter should include:
Date(s) of service under review
A brief explanation of why the resident required skilled services
Direction to where documentation supporting each component of the HIPPS code and technical requirements can be found
A contact name and phone number in case the reviewer has questions
This approach helps connect the dots between the claim and the supporting documentation.
Manage Timelines and Team Accountability
Time is one of the biggest challenges in a TPE audit. Receiving a request for 20 to 40 medical records with a 45-day turnaround leaves little room for delays. Teams should begin gathering documentation as soon as the audit letter is received.
Establish Internal Deadlines
Clearly defined internal deadlines help ensure records are collected, reviewed, and finalized well before the submission deadline. Each team member involved in the process should understand their role, responsibilities, and expected turnaround time.
Assign a Final Reviewer
The nurse assessment coordinator should be the final team member to review all documentation prior to submission. This final review helps ensure consistency between the MDS, clinical documentation, and the claim billed.
Follow Submission Instructions Carefully
TPE audit letters include specific instructions for how records must be returned. Failing to follow these instructions can result in records being rejected or claims denied. Whenever possible, utilize the Medicare Administrative Contractor (MAC) portal for uploading records. Portal submissions are often faster, more secure, and provide confirmation that records were received.
Preparation Builds Confidence
Preparing for a TPE audit does not have to be a reactive or overwhelming process. With the right structure, documentation practices, and expertise, organizations can approach audits with confidence and consistency. Engage Consulting partners with providers to strengthen MDS accuracy, documentation alignment, and audit readiness, helping teams reduce risk and improve outcomes. Whether you are navigating an active TPE review or looking to strengthen processes proactively, the right support can make all the difference.