Medicare Audit

Prepayment Reviews and Audits of Medicare Claims are Ongoing. Are Your Claims Being Audited?

(January 19, 2021):  As you will recall, on March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) suspended most Medicare audits and reviews due to the COVID-19 national emergency.  In early August, CMS instructed its contractors to resume their prepayment and postpayment audit activities. Over the last six months, we have seen a […]

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Preparing for a UPIC Audit? Examine These Eight Claim Elements

(Updated January 9, 2021): Each year, our attorneys and paralegals review and assess literally thousands of Medicare claims which have been audited (and denied) by Unified Program Integrity Contractors (UPICs) and other contractors working for the Centers for Medicare and Medicaid Services (CMS).  Are you preparing for a UPIC audit?  If your Medicare or Medicaid

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CBRs for Spinal Orthoses (CBR201803): What Do You Need to Know?

(April 12, 2018): The Centers for Medicare & Medicaid Services (CMS) utilizes a variety of private contractors to process Medicare claims and conduct both administrative and program integrity audits of claims submitted by healthcare providers and suppliers.  At the present time, CMS has contracted with eGlobalTech (eGT) to analyze data and prepare “Comparative Billing Reports”

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Medicare Chiropractic Audits are Increasing!

(June 5, 2017): Despite the fact that only three treatment services are covered by Medicare, the number of Medicare chiropractic audits conducted by the Department of Health Human Services (HHS), Office of Inspector General (OIG), has remained high over the last decade and is anticipated to grow throughout 2017 and 2018. As you are aware,

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Wake Up Sleep Labs! OIG is Concered About Questionable Billing Practices

(October 24, 2013): Over the next year, sleep lab / sleep medicine practices and clinics should expect to receive increased scrutiny from both the Department of Health and Human Services, Office of Inspector General (OIG) and from program integrity contractors working for the Centers for Medicare and Medicaid Services (CMS). These contractors may include Zone

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The Medicare Audit Improvement Act Appears Promising at First Glance. Is it Really the Answer?

(November 12, 2012): The AHA Supports the Medicare Audit Improvement Act of 2012. Is this Legislation Going to Help Physicians or Not? On October 16, 2012, a new bill was introduced by Representative Sam Graves (R-MO) entitled the “Medicare Audit Improvement Act of 2012”. This legislation was immediately supported by the American Hospital Association (AHA),

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A CMS ZPIC Contract is Quite Lucrative

(September 26, 2012): From the start, Zone Program Integrity Contractors (ZPICs) have worked to separate themselves from their proverbial “bounty hunter” peers – Recovery Audit Contractors (RACs). As you may know, ZPICs are paid on a contractual basis by the Centers for Medicare & Medicaid Services (CMS), instead of by how much money they return

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Medicare Administrative Appeals Process – An Overview for New Providers

(August 15, 2012): Is this your first time being audited by a Medicare Administrative Contractor (MAC) or a Zone Program Integrity Contractor (ZPIC)? If so, the brief outline below can provide a handy summary of the Medicare appeals process. I. Step 1 – Request for Information: In most instances, a health care provider will receive

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Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers

(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were

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