TPE isn’t a “someday” risk for home health and hospice agencies — it’s a 2026 reality.

by | Jul 30, 2026 | Social | 0 comments

Targeted Probe and Educate reviews target agencies with the highest risk profile: elevated denial rates or billing patterns that stand out from the rest of the market. With CMS’s 2026 enrollment moratorium, the new CRUSH program integrity initiative, and expanded TPE and UPIC activity, oversight is intensifying — and it isn’t only agencies doing something wrong who get pulled in. Rapid growth, high live-discharge rates, and ownership changes can trigger a closer look too.

The agencies that come through cleanly aren’t scrambling when the ADR letter arrives. Here’s how to get ahead of it:

  • Know your data. Pull your PEPPER report and track denial trends every quarter, not just at recert or survey.
  • Fix it in IDG. Document objective clinical decline tied to the LCD at every IDG, and assign an owner to close each narrative gap before the next visit.
  • Build response readiness. Know today who owns your ADR response and the submission deadline — TPE windows are tight, and missed deadlines can mean automatic denials.
  • Audit quarterly. Bring in an outside chart review each quarter — like Senior Options provides — to catch drift before a MAC does.

If your last documentation audit was at your last survey, that’s a gap worth closing now.

#Hospice #HomeHealth #TPE #ComplianceMatters #MedicareCompliance #IDG #SeniorOptions

Submit a Comment

Your email address will not be published. Required fields are marked *

Call 757-496-1740
Contact Us
Speak with a representative today!
or fill out our contact form.
Speak with a representative today!
Contact Us
Call 757-496-1740
or fill out our contact form.

Marlene Handler is a licensed physical therapist and healthcare leader with more than two decades of experience in home health, hospice, inpatient rehabilitation, and pediatric care. She currently serves as Interim Sr. Director of Clinical Operations for Senior Options, where she coaches and supports partner organizations on clinical operations, quality improvement, accreditation, and program design.
Marlene joined Senior Options in 2022 as Director of Quality and Compliance, leading accreditation efforts across the network — including CHAP, ACHC, and state surveys — while overseeing OASIS coding, compliance, and QAPI program development.
Prior to Senior Options, she served as Director of Clinical Operations and Home Health Administrator at Trinity Health at Home at Holy Cross Health, where she drove measurable improvements in STAR ratings, HHCAHPS, and Value-Based Purchasing performance. Earlier in her career, she led rehabilitation operations across adult and pediatric programs at Lamoille Home Health and Hospice in Vermont.
Marlene holds a Bachelor of Science in Physical Therapy from New York University and is bilingual in English and Spanish.

Emily Legner brings more than a decade of senior leadership experience in Home and Community Based Services to her role as President of Senior Options. A registered nurse with a unique blend of clinical expertise and business acumen, Emily has built her career at the intersection of patient care quality and operational excellence — leading large, multistate organizations through growth, transformation, and the ever-evolving landscape of healthcare regulation.

Prior to joining Senior Options, Emily served in executive operations roles across home health, hospice, and home care — including Vice President of Clinical Operations at Alliance Homecare, Vice President of Operations at Bridge Home Health & Hospice, and Divisional Director of Operations at Team Select Home Care. Across these roles, she oversaw organizations with revenues exceeding $250 million, managed census populations of thousands of patients, and led teams spanning multiple states. Her track record includes improving star ratings, expanding Medicaid programs, launching new service lines, and driving meaningful gains in both quality outcomes and financial performance.

Emily holds a degree in Nursing from Pima Medical Institute and a Bachelor of Science in Marketing and Finance from the University of Arizona — a combination that reflects the dual lens she brings to every engagement: clinical integrity and sound business strategy.

At Senior Options, Emily is committed to helping LeadingAge member organizations build, grow, and strengthen Home and Community Based Services so that more older adults can receive high-quality care right where they call home.

Karen started her medical career in 1984 as a registered nurse working in the intensive care unit and medical surgical. In 1999 she began working in home health, hospice and long term care earning various certificates as a Certified Nurse Executive, CNE; a Certified Wound Care Nurse, CWCN; a Certified Oasis Coder, COS-C; and in 2006 became a Licensed Nursing Home Administrator, LNHA. Before joining Senior Options in 2022, Karen also served as a Nursing Home Administrator for CCRC a skilled nursing facility, a Director of Operations for Home Health and Hospice, a Senior Executive Director for Long-term Care, a Preceptor for the Virginia Board of LTC Administrators and as a Nursing Instructor.

Karen has a bachelor’s degree in Nursing from Excelsior College in Albany NY and a Legal Nurse Consultant Certificate from Kaplan University.

As our Senior Director of Finance and Operations, Melinda is responsible for the finance, accounting, and billing team at Senior Options. And, she works with our current and prospective partners on budgeting, strategic initiatives, reimbursement, cost reports, and pro forma development.

Melinda brings over 25 years of financial management experience in the senior care environment. She has led the overall operations for six healthcare living centers, and two assisted living communities. She also has experience collaborating with multiple healthcare and state associations. Melinda currently serves as the Vice-Chair for the Virginia Society of Certified Public Accountants Board of Directors and is a member of the America Institute of Certified Public Accountants.

Melinda enjoys reading, traveling, walking, attending plays, and concerts.

Michelle’s experience in health care leadership spans for over 13 years. Before joining Senior Options, she served as the Administrator for Columbus Colony (the only deaf Nursing Facility in the country) where she was responsible for quality assurance and regulatory affairs, memory care, activities, policies and procedures, and resident care. Before that, Michelle served as the Vice President of Business Development for Senior Independence, now Ohio Living Home Health and Hospice, where she was responsible for growing home health and hospice by over 200% in seven owned and four partner home and community services agencies. Michelle also has 20 years of leadership experience in many Fortune 500 companies, including Gap Inc., IBM, and GTE, where she served in senior leadership positions in Sales, Marketing, and Client Services.

Michelle has a bachelor’s degree in Business Administration from Grand Valley State University, a Certificate of Economics from the University of Krakow in Poland, and a Master of Business Administration from Franklin University. Michelle is a CHAP, Certified Consultant.