“Finally Friday!” The New MAC Medical Review Strategy

Friday, August 25 2017

A Special Two Week 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 1 of 2

appeal academy | medical audit

The Old Way of Choosing Audits and When to Deny


appeal academy | medical audit

The NEW Way of Choosing Who & What to Audit

Get the Details

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

THIS WEEK, we begin a two-part series – it takes two weeks cuz there’s just tooooo much to go over in one hour – to review the recent changes to Chapter 3 of the Medicare Program Integrity Manual, PLUS how all that affects your hospital under the new MAC review strategy, which CMS just expanded beyond their two pilot programs and initiated nationwide, as of July 3, 2017. This new program, Targeted Probe and Educate Medical Review Strategy, aka TPE was updated as of August 14, 2017 on the CMS website. We have included the relevant downloads in the Handout section, below.

This first week, we will be going over the changes to the PIM that begin on page 26 of the PDF version of the manual.  Now, Sharon Easterling was the first of us to notice the changes going out and alerted the rest of us to this. But we were all a bit puzzled, at first – we weren’t really sure what all this was about, other than just clarifying some procedures for the MACs, ZPICs and other contractors.

Lo and behold… then CMS published their new TPE strategy, and it all made sense to us…

WHENCE – we are doing two shows about it all. Don’t MISS either one!

Oh, and BTW… please take our little POLL here, ok?

[socialpoll id=”2457604″ path=”/polls/2457604″ width=”600″]

THIS week, our Panel will be discussing :

  • WHAT is “Big Data”
  • WHAT is the Medicare Program Integrity Manual (MPIM)
  • WHAT changed in Chapter 3 of the MPIM
  • WHAT do those changes mean for provider audits
  • HOW will those changes affect new audits by MACs
  • HOW will those changes affect new audits by RACs
  • WHAT should you do to 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!

Get our handouts, below…

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Handouts for This Show


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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