MACs Must Now Publish TPE Denial Reasons Every Quarter. Here Is How Hospices Can Use Them.

Starting November 2, 2026, every Medicare Administrative Contractor has to show its work. Under CMS Change Request 14616, MACs must post Targeted Probe and Educate (TPE) results on their websites every quarter, including the most common reasons claims are being denied.

For hospice compliance teams, this is one of the most useful changes in years. It turns your MAC's denial patterns into a public checklist you can audit against before an ADR ever arrives.

What CMS Changed

One clarification matters. CMS noted that this change does not involve new regulatory or statutory policy. Your documentation requirements did not change. What changed is how much you can see.

A Quick TPE Refresher

TPE is the MAC's targeted medical review program. MACs use data analysis to select providers with unusual billing patterns or high error rates, review a sample of claims (typically 20 to 40 per round), and provide education. Providers that do not improve after up to three rounds can be referred to CMS for further action, which can include extrapolation or referral to a UPIC or RAC. See our TPE Audit Management overview.

Why This Matters for Hospices

Until now, most hospices learned what their MAC was denying the hard way: when their own claims got denied. Quarterly postings change that. You will be able to see which issues your MAC is targeting across your region, and which documentation failures are driving denials, before your agency is selected.

That makes the postings a self-audit blueprint.

Know Your MAC

Hospice claims are processed by the home health and hospice MACs: Palmetto GBA (Jurisdiction M), CGS (Jurisdiction 15), and National Government Services (Jurisdictions 6 and K). Confirm yours on your remittance advice or enrollment records before you start.

The 5-Step Quarterly TPE Self-Audit

Step 1: Set a quarterly trigger

Bookmark your MAC's TPE results page and set a recurring reminder for the first week after each new quarterly posting. Assign one owner.

Step 2: Log the hospice topics and top denial reasons

Record each hospice-related TPE topic and its top denial reasons in a running log so you can see how the list changes over time.

Step 3: Turn each denial reason into a chart test

A denial reason is only useful if your team knows what to look for. Here is how common hospice denial themes translate into chart checks:

| Common denial theme | What to check in the chart |

|---|---|

| Documentation does not support terminal prognosis | Physician narrative, measurable decline, functional and nutritional indicators |

| Certification or recertification issues | Timing, signatures, dates, and required narrative |

| Face-to-face encounter missing or late | Encounter documented and attested for third and later benefit periods |

| Election statement deficiencies | All required elements present, signed, and dated |

| No response to ADR | Tracking, ownership, and proof of submission |

These are illustrations. Your MAC's actual posted reasons should drive your test list. For more on denial patterns, see Common Hospice Denial Codes in 2026 and Medicare ADR Reason Codes: The 2026 Guide.

Step 4: Sample and score

Pull 10 to 20 recent claims, weighted toward higher-risk records such as long lengths of stay, non-cancer diagnoses, and later benefit periods. Score each chart against your test list and calculate an error rate per denial reason.

Step 5: Fix the process, then re-audit

If the same gap appears in multiple charts, it is a workflow problem, not a staff problem. Fix the step that produces the error, retrain, and re-run the audit next quarter. Keep a record of each self-audit and the corrective actions taken.

Two Mistakes to Avoid

The Bottom Line

Once the first quarterly postings go live after November 2, your MAC will be publishing what it denies. Agencies that turn that data into a quarterly self-audit will close gaps before reviewers find them. Agencies that ignore it will learn the same lessons through denials. Pair your self-audit with the Hospice ADR Response Checklist so every packet you submit reflects what you learned.