Medicare Contractors Must Now Post Why Claims Fail Their Audits. Read the List Before Your Claims Are Picked.

On September 30, 2026, CMS issued Transmittal 13971 (Change Request 14616). It updates the Medicare Program Integrity Manual, chapter 3, section 3.7.1.1. From November 2, 2026, each Medicare Administrative Contractor (MAC) must post its Targeted Probe and Educate (TPE) results on its website every quarter. For each topic it reviews, the posting must list at least the three most common reasons for denial. CMS says it made the change because the industry told it these postings are a useful way to see issues and trends, and it wants every MAC to publish them the same way.

This sounds like a small housekeeping change. It is more useful than that. The posting tells you, in the contractor's own words, why claims like yours are failing review right now.

How a TPE review works

TPE is how MACs review claims from providers they pick out with data. CMS says MACs choose providers with high claim error rates or unusual billing patterns, and services with high national error rates. A round usually covers 20 to 40 claims for one service. After each round, the MAC offers education, including a one-on-one session, and gives at least 45 days to make changes before the next round.

There can be up to three rounds. If the problem is not fixed after three, CMS says the MAC refers the provider to CMS for next steps. Those can include 100 percent prepayment review, extrapolation of an overpayment, referral to a Recovery Auditor, or other action. If you pass, CMS says you will not be reviewed again on that topic for at least one year.

The line in the same section that costs practices the most

The same manual section explains how the MAC calculates your error rate. It says the MAC includes claims denied because there was no response to an Additional Documentation Request (ADR). A claim can be correctly coded and fully documented and still count as an error, because the records never reached the reviewer.

That is the hidden part of most audit losses. The letter goes to an old address, or to a staff member who has left, or it sits in a portal nobody checks. The deadline passes, the claims are denied, and the error rate goes up. A higher error rate makes another round more likely.

What to do this month

This is general information, not legal advice. Four checks take less than an hour:

• Find your MAC's TPE page and read the newest posting for the services you bill most. Note the top three denial reasons for each.
• Pull ten paid claims for each of those services and check them against those reasons. Look at signatures, orders, medical necessity notes and time statements, whatever the posting names.
• Confirm where your MAC sends ADR letters: the mailing address and the correspondence address on your Medicare enrollment, and the portal account. Make sure a named person opens them every week.
• Set up a log for every ADR with the date received, the due date in the letter, the date sent and proof of delivery.

Then read the posting again each quarter. When a new topic appears for a service you bill, it is a signal that the MAC's data is pointing at that service now.

Why it matters

Most practices find out what an auditor wants after the first denial letter. From now on, the contractors have to say it first. If you want a second pair of eyes on where your claims are exposed, a revenue review can look at one payer's denials over the last 90 days and show which ones match the patterns auditors post.