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CMS will require Medicare Administrative Contractors to publish quarterly results from the Targeted Probe and Educate program, including the most common 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 will require Medicare Administrative Contractors to publish quarterly results from the Targeted Probe and Educate program, including common reasons for claim denials. The requirement takes effect Nov. 2, 2026 and covers contractors handling home health and hospice claims, among other sectors. The reports will provide information about the denial reasons identified in each TPE priority area.
Under the directive, contractors must post the most common denial reasons for each TPE priority area, listing the top three where applicable. CMS made additional denial reasons optional, while encouraging contractors to include more when the information would help providers and suppliers. The agency said the change is intended to make publication more consistent across Medicare contractors.
The TPE program is intended to address claim denials and appeals. The new requirement concerns what contractors report publicly; it does not change Medicare coverage rules. Providers will be able to review the published reasons and compare them with their own claims. The directive does not specify whether the reporting will affect denial rates.
LeadingAge Vice President of Policy and Government Affairs Mollie Gurian told Home Health Care News that the organization welcomed the requirement and wanted further discussions with CMS and its contractors about oversight. The National Alliance for Care at Home also described quarterly posting as a “welcome step toward greater transparency.”
How Denial Data Could Help Providers
Published denial reasons may help home health and hospice providers identify recurring documentation or billing problems and review their processes. The information may also show which issues contractors are addressing in each TPE priority area.
For providers working across different Medicare contractor jurisdictions, comparable quarterly reporting may make it easier to identify differences in reported denial reasons. LeadingAge said greater visibility could help advocates examine contractor actions and work with providers. The directive does not establish that current contractor practices are inconsistent.
The usefulness of the information will depend on how clearly and consistently contractors present it and how much detail they provide. The directive establishes a reporting requirement but does not guarantee fewer denials, faster payment or a particular outcome for any individual claim.
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Industry Requests for Clearer Reporting
The directive follows feedback from the health care industry to CMS that quarterly results would help keep providers informed, according to the agency’s Sept. 30 filing. CMS said the requirement is intended to promote consistency among Medicare contractors’ public reporting.
LeadingAge, a Washington-based advocacy organization representing more than 5,300 nonprofit aging-services organizations, including home-based care providers, had previously pressed CMS for greater access to claims information. In a March letter to CMS Administrator Dr. Mehmet Oz, Gurian wrote that better visibility could help providers understand where errors occur and why.
The National Alliance for Care at Home, based in Alexandria, Virginia, represents professionals in home health, home care, hospice and other fields. Both organizations support more transparent reporting. The source material does not provide a detailed implementation plan beyond the quarterly posting requirements.
“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
What Providers Still Need to Learn
The directive does not specify in the provided material how detailed each contractor’s posts will be, how easily providers will be able to compare reports, or whether CMS will assess the usefulness of the information after publication begins. The requirement calls for the top three denial reasons where applicable, but contractors may choose whether to report additional reasons.
It is not established whether greater visibility will lead to fewer denials, improved payment accuracy or changes in contractor oversight. Industry advocates have cited these as possible outcomes, but the reporting rule does not establish them. The source material does not give baseline denial rates or projections that would quantify any expected change.
Quarterly Reports Begin in November
The requirement is scheduled to take effect Nov. 2, 2026. Medicare Administrative Contractors covered by the directive will then need to post quarterly TPE results on their websites, including the most common denial reasons for each priority area and the top three where applicable.
Providers and industry groups can review the reports as they appear. LeadingAge has said it plans to continue discussions with CMS and its contractors about further recommendations. The source material does not identify a separate CMS review date or a subsequent milestone.
Key Questions
What is CMS requiring Medicare contractors to publish?
Contractors must post quarterly Targeted Probe and Educate results, including the most common denial reasons for each priority area and the top three where applicable.
When does the requirement take effect?
The requirement is scheduled to take effect on Nov. 2, 2026.
Does the directive change Medicare coverage?
No. The update changes contractors’ reporting obligations; it does not change Medicare coverage rules.
Will the new reporting reduce home health denials?
That is not established. Advocacy groups say visibility into common denial reasons could help providers detect and correct errors, but the directive does not guarantee fewer denials or provide a quantified forecast.
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