“Finally Friday!” The New MAC Medical Review Strategy – Part 2

Friday, September 8 2017

Part 2 of Our Special Series

The New MAC Medical Review Strategy:
Increased Data Analysis & TPE


How Changes to the Medicare Program Integrity Manual Will Affect You, What these New Audits Will Focus On, and Why You Should Care

Part 2 of 2

appeal academy | medical audit

An excerpt from a Notice Letter send to a hospital by a MAC, informing them they are chosen for a Targeted Probe & Educate Audit related to the billing of a Chemo drug administration.

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Finally Friday! Broadcasts are Sponsored by
The Health Law Partners, ZirMed,
and MAS Coding Solutions

THIS WEEK, we offer Part DEUX of a two-part series – explaining how the new MAC review strategy, which CMS expanded to now be nationwide, as of July 3, 2017. The new program, Targeted Probe and Educate Medical Review Strategy, aka TPE was updated as of August 14, 2017 on the CMS website. We have again included the relevant downloads in the Handout section, below.

Anyway, we will be going over the new TPE strategy, and looking at how CMS does auditing – which is not really a mystery. Now, it may appear to YOU to be a mystery, but it is NOT a mystery to a seasoned auditor, like Bill Malm.

Whence, Bill will be reviewing how audit processes work, particularly since they are all laid out in some government manuals known as the Yellow Book. No, not the Yellow Pages, the Yellow BOOK.

Here’s what we suggest YOU get out of a review like this – ask yourself this question:

What’s in YOUR Audits?


  • Would your own internal audit process have noticed the same thing that the MAC found in the chart above?  
  • If NOT, then WHY NOT?  Or isn’t anyone even looking for such things???


  • If they did notice the change, WHAT WAS DONE to explain the change internally?
  • Or did no one even ask the question???

SO… THIS week, our Panel will be discussing :

  • WHAT was meaningful in the changes to the Program Integrity Manual (MPIM)
  • WHAT changed in TPE compared to before January 1 2017
  • WHAT does a government audit process look like
  • WHAT should internal provider audits look like
  • WHAT do these audit letters look like (we have excerpts)
  • HOW can you prepare for these audits
  • HOW should you deal with these new audits

So join us, share your own insights and bring your questions for us!

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Handouts for This Show


Handouts from LAST WEEK – still nice to have!


MPIM Chapter 3 with Highlights 658.69 KB 63 downloads



MPIM Chapter 6 with Highlights 292.25 KB 44 downloads



Red River HFMA Provider Bundle Flyer 221.01 KB 35 downloads



Red River HFMA Agenda at a Glance 190.82 KB 33 downloads



CMS Stylized Ouija Board for MACs 536.57 KB 48 downloads


Video Replay of THIS WEEK's Show

CCMA CMAS CEU Certificate

Video Replay of the PREVIOUS Show

Visit the archive for the show to get the original handouts

Visit the archive of ALL PREVIOUS SHOWS with handouts & video

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