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Navigating CMS's New 5-Chart TPE Process

Navigating CMSs New 5-Chart TPE Process (1)

Let’s shed some light on the Targeted Probe and Education (TPE) we are seeing around the 43 states HealthPRO Heritage (HPH) operates in today with the recent introduction of CMS's 5-Chart TPE process alongside existing Medicare Part A & B TPE initiatives. Let's delve into this topic with our own Vice President of Revenue Integrity, Diane Palacio, and how we at HealthPRO Heritage can help to prepare and safeguard our partners from the potential impact of such audits.

Overview of the new 5-Chart TPE process and its significance for our partners:

The 5-Chart TPE process is an extension of CMS's Targeted Probe and Educate (TPE) audits, aimed at improving claims precision through education and oversight. Under Medicare Part A, skilled nursing facilities (SNFs) now face meticulous reviews of MDS/HIPPS coding documentation, highlighting the importance of accurate coding. For home health agencies, the focus shifts to substantiating OASIS coding under TPE.

When facing a TPE audit, swift and collaborative action is essential. First in order to be prepared, immerse yourself in TPE expectations by referring to CMS and MAC websites. Understanding the specific requirements is crucial for a successful response. Once you receive a TPE, the first step is to inform your rehab director or Regional VP and share any MAC communications received. This ensures that your organization is well-prepared to address the audit.

At HPH, we understand the challenges our partners face in navigating these audits. That's why we provide our HPH Partners with access to extensive documentation resources through PDPM University. We provide our customers with access to our online trainings by role as well as our up-to-date monthly PDPM U & Beyond trainings and resources, which we continuously update as new strategies and changes are released. These resources empower our partners with the knowledge and tools they need to navigate TPE audits successfully. You can gain access to these resources by emailing education@healthpro-heritage.com.

While these TPE’s are unavoidable, we know that a successful audit outcome starts long before the TPE notification arrives in the mail! At HPH our operations, clinical and compliance teams constantly monitor multiple data sources that help us identify potential audit risks and ensure our clinicians have access to training and education resources to mitigate this risk.

In conclusion, TPE audits are an opportunity for improvement through proactive preparation, intentional education and collaboration. HPH remains dedicated to providing unwavering assistance to our partners as we tackle TPEs.


Thank you, Diane Palacio, for shedding light on the new 5-Chart TPE process and how HPH is committed to supporting its partners during these challenging times. As we've learned today, being proactive and well-informed is crucial when facing TPE audits. Complete the form below to register to continue to receive more informative content from HPH as we continue to navigate the ever-evolving healthcare landscape together.