TPE Audit Support for Skilled Nursing Facilities

Navigate TPE Audits With Confidence. Protect Compliance and Cash Flow.

Targeted Probe and Educate (TPE) audits are now a reality for skilled nursing facilities across the country. Triggered by documentation trends, TPE audits can significantly impact reimbursement and lead to significant financial and operational disruption if not handled correctly.

Richter provides end-to-end TPE audit support that helps skilled nursing facilities prepare proactively, respond effectively and reduce long-term audit risk.

What Is a TPE Audit?

A Targeted Probe and Educate (TPE) audit is a Medicare medical record review process conducted by your Medicare Administrative Contractor (MAC). Facilities are selected based on data analysis indicating elevated error rates, unusual billing practices, or services associated with high national denial trends.

Unlike the prior 5-claim probe audit, current TPE audits:

• Review larger volumes of claims

• Occur over multiple rounds if error rates persist
• Can escalate to extrapolation, or further CMS action

Although TPE auditors provide education it is only after the facilities error rate is higher than allowed meaning the facility will proceed to another round of audits.

Why TPE Audits Matter to SNFs

TPE audits affect far more than compliance teams.

Financial Impact

• Delayed reimbursement during claim review
• Partial or full denials
• Payment recoupments on post-pay claims
• Significant cash flow exposure across multiple residents and billing periods

Operational Impact

• Disruption to clinical and billing workflows
• Increased administrative burden
• Ongoing audit cycles if improvement thresholds are not met

Escalation Risk

• 100% prepayment review
• Overpayment extrapolation
• Referral to additional audit or enforcement programs

This is why successful TPE management requires both clinical and financial expertise working together.

Common TPE Audit Denial Drivers

Many denials stem from education and documentation gaps rather than intent. The most common issues we see include:

• Documentation that does not clearly support medical necessity
• MDS coding that is not supported in clinical documentation
• Lack of knowledge surrounding MDS coding rules impact on PDPM reimbursement.
• Missing or late physician certifications and recertifications
• Failure to deliver a Notice of Medicare Non-Coverage
• Mismatches between the medical record, the MDS, and PDPM billing
• Incomplete ADR submissions or failure to respond to the TPE ADR

Left unaddressed, these issues often repeat across audit rounds.

How Richter Helps

Richter supports skilled nursing facilities across the entire TPE audit lifecycle, from preparation through resolution.

TPE Audit Readiness

We help facilities identify risk before an audit occurs by reviewing:

• Documentation practices and MDS alignment
• Certification and recertification processes
• Internal controls and workflows
• Claims and billing patterns

The goal is early identification of vulnerabilities that could trigger a TPE audit or drive denials once one begins.

Audit Response & Education Support

If your facility has received a TPE notice, we provide hands-on guidance to:

• Interpret MAC requests and deadlines

• Define audit scope and priorities
• Assemble complete, compliant documentation
• Ensure ADR submissions are accurate, timely, and organized
• Support interdisciplinary teams during education and review periods

We focus on reducing repeat findings and preventing escalation.

Post-Audit Correction & Ongoing Risk Reduction

After audit results are received, we help facilities:

• Analyze denial trends and root causes
• Develop corrective action plans
• Improve documentation and MDS practices
• Educate clinical, billing, and leadership teams
• Strengthen internal audit and monitoring processes
  

The objective is sustainable improvement, not short-term fixes.

Why SNFs Choose Richter’s TPE Audit Support

• Deep experience in post-acute clinical and financial operations
• Integrated clinical and revenue cycle perspective
• Practical, audit-tested guidance
• Focus on protecting both compliance and cash flow
• Clear communication with leadership and frontline teams

We don’t just explain audit findings — we help facilities change outcomes.

When to Engage TPE Support

Facilities typically reach out when:

• A TPE audit notice has been received
• Denial rates remain high after initial education
• Cash flow disruption becomes a concern
• Leadership wants to reduce audit exposure proactively
• Prior probe audits revealed recurring issues

Earlier engagement almost always leads to better results.

Talk With a TPE Audit Expert

Whether you’re preparing for a potential audit or actively navigating a TPE review, having experienced guidance can make the difference between education and escalation. Contact Richter to discuss TPE audit readiness, response support, or ongoing compliance risk reduction.