US · guidance
CMS Pub. 100-09, ch. 6, § 20.3.6.2
Education Resulting from MR Referrals
In accordance with Pub. 100-08, Medicare Program Integrity Manual, Chapters 1 and 3, the MAC’s
MR area shall analyze MR data and make two types of education referrals to POE: probe review
referrals and priority referrals.
A. Probe Review Referrals: Providers receive a notification letter when MR staff perform a
probe review that may include an offer for provider education to address the issues found
in the probe. If a provider requests education in response to one of these letters, POE
staff shall be responsible for providing this education. MACs determine the appropriate
type of education, including one-on-one training or referring the provider to available
web training or upcoming workshops about the topic. POE staff shall have access to the
probe notification letters in case a provider contacts POE staff to request education.
B. Priority Referrals: MR staff initiate priority referrals when they believe education will
help a provider or small group of providers prevent further errors and reduce fraud. POE
staff should collaborate with MR staff to evaluate these referrals and determine what type
of education, if any, is appropriate and whether this education aligns with the overall
MAC strategy to reduce error rates.
The MAC has no obligation to provide specific education for all MR referrals. Instead, the MAC shall
determine the education they provide because of MR referrals based on their goal to reduce the error rate
using available resources. MACs have discretion over the type of education and clinical staff
involvement. MACs shall not charge for this education. (See section 20.7.1 of this chapter.)
POE staff shall provide timely feedback to MR staff about referral dispositions, including whether a
provider requested education in response to a probe letter. POE staff shall work with MR staff to
develop an effective communication system that, at a minimum, tracks MR staff referrals, provider
education requests, follow-up communications with MR staff, and problem disposition, including type
of education provided.
History
(Rev. 13683; Issued: 04-08-26; Effective: 05-08-26; Implementation: 05-08-26)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e9eaffc4fc09304fcb4bd87f8aadea44c437c5aa3daf2ca214c2e4538e1558fe
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