Stronger Documentation. Fewer Denials. Better Outcomes
Avoiding Payback in Hospice TPE Audits
Learn how proactive compliance and strong documentation can help your hospice avoid costly paybacks during TPE audits.
Know the Process. Avoid the Pitfalls.
Understanding the Hospice TPE Process
Gain clarity on the hospice Targeted Probe and Educate (TPE) process, from claim selection to education, and learn how to prepare effectively
The answer depends on where you are in the process and the level of risk your organization faces.
When to Use a Lawyer vs. a Consultant in a Hospice TPE Audit
Hospice providers know that CMS audits can feel overwhelming. The Targeted Probe and Educate (TPE) process, in particular, is designed to review billing practices, educate providers, and reduce claim errors. But when your hospice receives a TPE letter, a common question arises: Do we need a consultant, or should we hire a lawyer?
You’re Not Alone—We’re Here to Help You Stay Audit-Ready.
Why Hospices Are Under the Microscope: CMS Audit Trends Explained
Over the past decade, the hospice industry has experienced a dramatic increase in the number of CMS audits. From Targeted Probe and Educate (TPE) reviews to RAC and UPIC investigations, hospices are under more scrutiny than ever before. But why has the audit rate become so high? The answer lies in a mix of industry growth, compliance challenges, and government oversight priorities.
FAQs
Explore FAQs on hospice CMS audits and see how expert consulting support can protect your agency from denials and costly repayments
What is a CMS audit, and why might my hospice be selected?
A CMS audit is a review conducted by Medicare contractors to verify that hospice claims are billed correctly and supported by documentation. Hospices may be selected based on billing patterns, length of stay concerns, high utilization of certain levels of care, or random sampling.
What types of CMS audits can affect hospices
Hospices may face several types of audits, including:
- TPE (Targeted Probe & Educate) – education-focused, up to 3 rounds of claim reviews.
- UPIC (Unified Program Integrity Contractor) – investigates suspected fraud or abuse.
- RAC (Recovery Audit Contractor) – identifies and corrects improper payments.
- SMRC (Supplemental Medical Review Contractor) – targeted reviews based on CMS projects.
How far back can auditors look at hospice claims?
In most cases, CMS contractors can review claims up to 4 years after payment (the “reopening window”). In certain situations involving suspected fraud, they may look back further.
What happens if my hospice fails a TPE audit?
If your hospice does not correct errors after three rounds of TPE, your case may be referred to other CMS contractors (such as UPIC or RAC) for expanded or extrapolated reviews. This could result in significant repayment demands.
What documentation is most important in defending hospice claims?
Surveyors and auditors look for:
- Physician certification and recertification of terminal illness
- Face-to-face encounter documentation (when required)
- Interdisciplinary Group (IDG) notes and Plan of Care updates
- Comparative documentation of patient decline across disciplines
- Complete visit notes showing skilled need and interventions
How can a hospice prepare for a CMS audit?
The best preparation is continuous compliance. Hospices should:
- Train staff on defensible documentation practices
- Conduct routine internal chart audits
- Ensure timely signatures and certifications
- Keep policies and procedures updated
- Engage expert consultants for mock audits or staff education
Protect Your Revenue Today
Don’t wait until an audit letter arrives. Our team of hospice compliance experts is here to help you strengthen documentation, train staff, and stay audit-ready. Whether you need guidance on TPE, RAC, or UPIC reviews, we’re just a message away.
👉 Contact us today to schedule your free consultation and discover how we can support your hospice with compliance, education, and peace of mind.
Practical Tools to Keep Your Hospice Audit-Ready.
Downloadable Resources
Hospice Audit Basics-Staff Education and Quiz
This handout introduces hospice staff to the basics of CMS audits, including the types of reviews, key documentation requirements, and staff responsibilities. It is designed to build awareness and promote strong, defensible documentation practices.
CMS Audit Readiness Checklist
A one-page quick reference that outlines the essential documents hospices must have ready at all times, including certifications, face-to-face encounters, IDG notes, and plan of care updates.
Hospice CMS Audit Risk Assessment Tool
Are you audit-ready? Our Hospice CMS Audit Risk Assessment Tool makes it easy to spot compliance gaps before auditors do. Download this free resource to strengthen your documentation, improve oversight, and protect your hospice from costly denials.New Paragraph
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