One on One Education

7.2.2.18 - One on One Education (Rev. 835; Issued: 10-12-18; Effective: 11-13-18; Implementation: 11-13-18) This applies to MAC and SMRC. One-on-one education places emphasis on reducing the paid claims error rate by notifying, either in writing or orally, the individual billing entities (i.e., providers, suppliers, or ordering clinician) of review findings identified on specific claims or a group of claims reviewed on probe or targeted medical review by the MAC, RAC, or SMRC, or based on billing patterns identified by data analysis (e.g., CBRs, OIG reports, PEPPER/FATHOM reports, RAC findings, CERT improper payment findings). • One-on-one education does not include: • Educational articles impacting nationwide issues • Responses to inquiries on claims that were not medically reviewed • General training sessions • POE education activities • Speaking at society meetings • Writing articles in society newsletters regarding new or significantly revised LCDs. Note: For the purpose of Targeted Probe and Educate (TPE) and TPE specific reporting, letters shall not be considered or reported as one on one education. Please see PIM chapter 3, section 3.2.5 for details regarding the definition of TPE one-on-one education.