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 increases the likelihood of additional audit cycles, deeper scrutiny, cash flow disruption, and long-term reimbursement impact. 

TPE audits demand immediate attention, structured processes, and expertise. 

The Reality of TPE Audits: High Risk and Little Time 

TPE reviews are time-sensitive by design. Facilities are often asked to submit 20 to 40 medical records within a 45-day window. That timeline leaves little room for disorganization, staff shortages, or uncertainty about documentation expectations. Additionally, lack of complete understanding and strategy for TPE responses routinely lead to denials and additional audit cycles.  When gaps exist, the risk of denial increases significantly.  Some of the most common errors include: 

• Incomplete records or not including supportive services that occurred outside of the reporting period, which support HIPPS coding 

• Not providing a detailed companion memorandum that outlines specific supportive documentation 

• Lack of clarity around substantiating skilled services 

• Not meeting submission timelines 

When these gaps exist, the risk of denial increases significantly. 

Why Failing the First Review Matters 

Passing the first review is critical. TPE audits and denials are not administrative inconveniences. They are financial and operational risks that deserve focused attention. Waiting until denials occur or cash flow is disrupted often limits available options.  Organizations that approach TPE audits reactively often find themselves caught in a cycle of denials and ongoing oversight.  

Failing a TPE review does not simply end with a denial. It often triggers: 

• Selection for additional TPE rounds 

• Increased audit frequency 

• Delayed or disrupted cash flow as future audits require pre-payment completion 

• Greater exposure to future reimbursement reductions 

Passing the first review is critical. Organizations that approach TPE audits reactively often find themselves caught in a cycle of denials and ongoing oversight. 

Two Paths Forward: We Manage the Complete Process or We Train Your Team 

There is no one-size-fits-all approach to managing TPE audits and denials. Engage Consulting supports providers in two distinct ways, depending on internal capacity and needs. 

TPE Audit Option 1: We Manage the Complete Process  

Engage Consulting will manage the audit and denial process from start to finish.  This approach is especially helpful for organizations facing immediate audits, lacks internal experience/expertise, staffing constraints, or repeated denials.  

TPE Audit Option 2: We Train Your Team 

Engage Consulting offers one-on-one training and education of staff member(s) to create internal competencies, standardized tools/templates, and reliable processes to respond to audits. Training empowers teams to respond confidently and consistently, strengthening processes well beyond a single audit.   

Do Not Wait Until the Impact Is Felt 

TPE audits and denials are not administrative inconveniences. They are financial and operational risks that deserve focused attention. Waiting until denials occur or cash flow is disrupted often limits available options. 

Whether your organization needs education, hands-on support, or full audit management, Engage Consulting helps providers navigate TPE audits with clarity, confidence, and control. 

The risk is high. The timelines are tight. The right support can make the difference between passing the first time and facing ongoing scrutiny.