TL;DR
CMS will require Medicare Administrative Contractors to publish quarterly results from the Targeted Probe and Educate program, including up to the top three denial reasons for each priority area. The requirement takes effect Nov. 2, 2026, and changes reporting obligations, not Medicare coverage rules.
The Centers for Medicare & Medicaid Services (CMS) will require Medicare Administrative Contractors to publish quarterly Targeted Probe and Educate results, including leading claim denial reasons, beginning Nov. 2, 2026. The directive covers contractors handling home health and hospice claims, among other sectors, and is intended to give providers clearer information about claim problems and oversight trends.
Under the requirement, Medicare contractors, known as MACs, must post quarterly findings from the Targeted Probe and Educate (TPE) program on their websites. For each TPE priority area, contractors must list the most common denial reasons, including the top three where applicable. Publishing additional reasons is optional, though CMS encouraged contractors to include more information when it would help providers and suppliers.
The agency’s Sept. 30 filing says the change follows feedback from the health care industry that quarterly results would help keep providers informed. CMS said the requirement is intended to make publication more consistent across Medicare contractors. The rule applies to contractors covering home health and hospice claims as well as other health care sectors.
The directive changes contractor reporting requirements, not Medicare coverage policy. It does not, based on the source material, alter what services Medicare covers or guarantee that a claim will be paid. Instead, the public reporting is meant to show providers recurring reasons claims are denied during the TPE process, so organizations can review their own documentation and billing practices against those patterns.
How Denial Data Could Help Providers
For home health providers, seeing frequently cited denial reasons could make it easier to identify documentation or billing errors before they recur. The information may also help organizations understand which issues contractors are examining within particular TPE priority areas. CMS and the advocacy groups cited in the report frame the change as a way to improve transparency; whether it reduces denials in practice remains to be seen.
The reports could also help providers and advocates compare how contractors describe denial trends. LeadingAge said greater visibility would help advocates identify differences among MACs and work with providers when oversight actions appear inconsistent with regulations. That comparison could give organizations more concrete information when raising concerns, though the directive itself does not establish a new process for resolving disputes or standardize how claims are decided.
The practical value will depend on the detail and consistency of the material contractors publish. CMS requires the leading reasons for each priority area, but publication beyond the top three is optional. Providers may therefore receive different levels of detail across contractors, even as the agency seeks more consistent reporting.
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A Response to Provider Feedback
The TPE program is intended to reduce claim denials and appeals through targeted review and education. The new requirement adds a public reporting obligation to that process: contractors must post quarterly results rather than keeping the relevant information less visible to providers. The source report does not describe changes to the program’s review criteria or to Medicare’s underlying coverage rules.
Advocacy groups have pressed CMS for more claims information. In a March letter to CMS Administrator Dr. Mehmet Oz, LeadingAge Vice President of Policy and Government Affairs Mollie Gurian argued that visibility into where and why errors occur could improve payment accuracy. LeadingAge represents more than 5,300 nonprofit aging-services organizations, including home-based care providers. The National Alliance for Care at Home represents professionals in home health, home care, hospice and other fields.
The organizations welcomed the reporting directive, while describing it as an initial step rather than a complete answer to concerns about oversight. CMS’s stated aim, as described in the filing, includes both informing providers and making publication more consistent across Medicare contractors.
“Overall, we think that this is great first move and look forward to continuing discussions with CMS and its contractors and advancing recommendations for other actions that’ll result in more targeted and transparent oversight.”
— Mollie Gurian, LeadingAge vice president of policy and government affairs, speaking to Home Health Care News
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What Providers May Still Not See
It is not yet clear how much detail each contractor will publish beyond the required top denial reasons, since additional reasons are optional. The source material also does not specify a common format for the web postings, how easily providers will be able to compare results across MACs, or whether CMS will separately evaluate compliance with the posting requirement.
The directive’s effect on denial rates, appeals, payment accuracy or provider workload is also unknown. Advocacy groups say the information could help providers correct errors and identify inconsistent oversight, but those are anticipated benefits rather than measured outcomes reported after implementation. The change does not revise Medicare coverage standards, and public denial trends alone may not explain the circumstances behind an individual claim decision.
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Quarterly Posts Begin in November
The requirement is scheduled to take effect on Nov. 2, 2026. Medicare contractors will then be expected to post quarterly TPE results and the most common denial reasons for each applicable priority area. Providers and advocacy organizations will be able to review the postings as they become available and assess how much detail contractors provide.
After implementation, a key point to watch will be whether reporting is consistent across MAC websites and whether the published information helps providers spot recurring issues. LeadingAge said it plans to continue discussions with CMS and its contractors and advance recommendations for further oversight changes. The source report does not identify a later CMS review date or announce additional changes to Medicare claims policy.
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Key Questions
What is CMS requiring Medicare contractors to publish?
Medicare Administrative Contractors must post quarterly results from the Targeted Probe and Educate program, including the most common denial reasons for each priority area. The top three reasons must be listed where applicable; additional reasons may be included at the contractor’s discretion.
When does the reporting requirement take effect?
The requirement is scheduled to take effect on Nov. 2, 2026. Contractors will be expected to publish quarterly results on their websites.
Does this change Medicare coverage or guarantee fewer denials?
No coverage change is described. The directive changes contractor reporting obligations, not Medicare coverage rules. CMS and advocacy groups expect better visibility could help providers address errors, but the source material does not establish that denials will fall.
Which providers could be affected?
The requirement applies to MACs overseeing home health and hospice claims, among other health care sectors. Providers may use the published denial patterns to review issues relevant to their claims, though the postings will not determine the outcome of any individual claim.
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