RAC Audit & TPE/Claim Probe Support for SNF
ADR letters answered. Records packaged. Education rounds passed. CMS Recovery Audit Contractor (RAC) and Targeted Probe and Educate (TPE) response support. 45-day response windows tracked. Four RAC contractor regions covered (A, B, C, D). TPE three-round education process. Chart compilation by post-acute trained specialists. 800+ providers trust us. Pilot in 2 weeks.
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0:48ADR letters pile up. 45-day clock ticks. Auto-denials hit at day 46.
When the MAC, RAC, or UPIC sends an Additional Documentation Request (ADR), the provider has 45 calendar days to deliver the medical record packet. Miss the deadline and the claim auto-denies. TPE rounds escalate every 30 days if error rates exceed CMS thresholds. Without dedicated audit response, ADRs sit in a desk drawer.
ADR letters missed entirely
ADRs arrive by mail or via the MAC portal. Without a dedicated tracker, half land in the wrong inbox and the 45-day clock starts without anyone watching it. Day 46 brings an auto-denial.
45-day record packet not built
Building an ADR-compliant medical record packet takes hours per claim: MDS, physician orders, therapy notes, nursing notes, MARs, and a coversheet that maps each document to the date of service. Without a specialist, the packet ships incomplete and the claim denies.
TPE rounds fail without education
TPE Round 1 reviews 20 to 40 claims. Error rate above the MAC threshold triggers Round 2. Round 2 above threshold triggers Round 3. Round 3 above threshold escalates to RAC, ZPIC, or UPIC referral. Without staff for the education calls, providers lose all three rounds.
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Send us your situation and our team will scope the right setup, usually within one business day. No obligation.
What is RAC audit and TPE/claim probe support ?
RAC audit and TPE/claim probe support is the workflow for responding to Medicare audit programs. The CMS Recovery Audit Contractor (RAC) program identifies improper payments after the fact and recoups them. RAC is run by four regional contractors covering Region A (Northeast), Region B (Midwest), Region C (Southeast), and Region D (West). The Targeted Probe and Educate (TPE) program runs through the MAC and selects 20 to 40 claims per provider per round, with up to three rounds. Both programs start with an Additional Documentation Request (ADR) letter giving the provider 45 calendar days to deliver the medical record.
What your RAC audit and TPE response team handles, day to day
Eight production tasks every ADR letter hits before the 45-day deadline lands.
ADR intake and 45-day tracker
Logs every incoming ADR letter from MAC, RAC, ZPIC, UPIC, or SMRC. Starts the 45-day clock the day the letter arrives.
Medical record compilation
Pulls MDS, physician orders, certifications, therapy notes, nursing notes, MARs. Builds the packet to CMS ADR specifications.
Coversheet and indexing
Builds the required coversheet mapping each document to the claim service line and date of service. CMS standard indexing.
esMD or MAC portal submission
Submits packets via esMD electronic, MAC web portal, or certified mail per CMS requirement. Confirms receipt and tracking number.
TPE education rounds
Attends MAC education call with the facility billing lead. Documents findings. Tracks error rate against the MAC pass threshold.
RAC region coverage
Region A (Performant), Region B (Cotiviti), Region C (Cotiviti), Region D (HMS) covered. Knows each contractor's preferences.
Findings response and appeal
For unfavorable RAC findings, files Level 1 redetermination within 120 days. Tracks the 5-level appeal ladder.
Audit findings reporting
Weekly ADR count and aging. Monthly TPE error rate, RAC takeback dollars, and education round results for QAPI.
TPE and RAC audit trained, not generic chart pullers
Most outsourcing firms treat ADR response as filing. We do not. Our audit response specialists pass a CMS ADR documentation requirements test and a TPE rounds procedure test before they ever pack a live medical record for your facility.
ADR + TPE procedure tested
Every specialist passes a written assessment on CMS ADR documentation specs (MLN Matters), TPE three-round process, four RAC contractor regions and their working preferences, and the 45-day response clock before placement on a live account.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR 405 Subpart I (appeals), 42 CFR 424 conditions of payment, and 45 CFR 164.514 de-identification. All four certificates available on request.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live ADR response and chart compilation at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic offshore
Cost math for a single full-time audit response specialist at a mid-size SNF or LTC operator.
From "let's talk" to first ADR packet shipped in 1 to 2 weeks
Six steps. Each one is documented.
Discovery call (15 min)
Share your open ADRs, recent RAC region letters, and any active TPE round. We map the urgent 45-day deadlines first.
BAA + access
BAA signed. Role-based access to your EMR, the MAC portal (PECOS, eServices), and esMD.
ADR template calibration (2 to 3 days)
ADR documentation checklists per audit source (RAC, MAC TPE, ZPIC, UPIC, SMRC). Coversheet templates locked.
Parallel audit response starts
Week 2 to 3. Specialist works urgent ADRs first (closest to 45-day deadline). Daily 15-minute sync. You see every packet before submission.
Decision point (end of week 2)
ADRs answered on time, packet completeness rate, TPE round error rate. Go or no-go. No penalty if you cancel.
Full handoff, cadence locked
Weekly ADR aging report. Monthly TPE error rate. Quarterly RAC takeback dollars review with QAPI committee.
How your audit response specialist's day actually looks
A real shift, hour by hour. Coverage rotates so your ADR queue is never dark during business hours.
How Staffingly works, in practice
Inside the workA trained Staffingly specialist works inside your existing platform, with clear escalation back to your team.
One Flat Weekly Rate. No Surprises.
Dedicated senior care schedulers at a fixed weekly cost. Per scheduler FTE, per week. No contracts, no minimums, no hidden fees.
Want to compare against an in-house hire? Use the savings calculator.
Frequently asked questions
How many TPE rounds are there?
Up to three rounds. Round 1 reviews 20 to 40 claims. Above MAC error threshold triggers Round 2 with mandatory education call. Round 2 above threshold triggers Round 3. Round 3 above threshold escalates to RAC, ZPIC, or UPIC.
What is the ADR response time?
45 calendar days from the date of the ADR letter. Miss the deadline and the claim auto-denies on day 46. No extension absent extraordinary circumstance. Runs even on weekends and holidays.
How is the RAC program structured by region?
Region A (Performant Recovery) Northeast. Region B (Cotiviti) Midwest. Region C (Cotiviti) Southeast. Region D (HMS) West. Each contractor publishes its own approved issue list.
What is the difference between RAC and TPE?
RAC is post-payment enforcement that recoups improper payments. TPE is MAC-run education with 20 to 40 claims per round, up to three rounds, with mandatory education calls between rounds. Both start with an ADR and run on the 45-day clock.
What is the best practice for chart prep on an ADR?
Include every document tied to the claim service line: MDS, physician certification and recertification, therapy notes, nursing notes, MARs, physician orders, face-to-face encounters. CMS-standard coversheet maps each document to the claim service line and date of service. Submit via esMD or MAC portal where supported.
How long is a TPE education round?
A 30 to 60 minute MAC-hosted call between rounds, scheduled within 30 days of round findings. The MAC reviews erred claims, documentation gaps, and CMS rules missed. A documented education response is required for the MAC to score the round.
How does pricing work?
Per audit response specialist FTE per week. $399 Standard, $349 Volume (3+), $299 Enterprise (10+). No setup fees. No annual contracts.
What is included in the 2-Week Risk-Free Pilot?
Two weeks of live ADR response and chart compilation parallel with your business office. Specialist works urgent ADRs first (closest to 45-day deadline). Daily KPI reporting on ADRs answered on time, packet completeness, and TPE error rate. No penalty if you cancel before day 14.
President and CEO, Staffingly, Inc. 25+ years in IT consulting and healthcare BPO operations. One of the earliest US operators to set up an RPO/BPO delivery network in India. Leads AI-driven home care workflows that help agencies, home health providers, and multi-branch operators cut admin cost without compromising care.
