Providers may, from time to time, face an audit from Medicaid and Medicare for their billing practices. In recent years, Medicaid and Medicare have cracked down on improper payments. According to The Hill, since 2011 Medicare and Medicaid have hired private contractors to audit, identify, and recover improper payments made to providers and physicians. Recently, the program has been expanded to audit Medicare Advantage (Part C) and prescription drug plans. The Centers for Medicare and Medicaid Services can review and audit services it believes may have been improperly billed. Auditors face incentives when they collect payments, so they may aggressively look for any discrepancies during an audit. Providers may need to supply documentation, support, and other evidence to substantiate their billing practices.
Receiving a notice of “overpayment” can be stressful for providers. While it is possible to initiate a Medicaid provider appeals process on your own, many providers find the appeals process complex. A Medicaid provider appeals attorney in Jackson, Mississippi may be able to assist you and help you navigate the appeals process. The Heilman Law Group, PA can take a look at your audit and help you plan the best possible course of action forward.
ZPICs audits (or Zone Program Integrity Contractors) have the ability to perform fraud investigations into providers and healthcare professionals who bill Medicaid and Medicare. ZPICs investigate intentional overbilling and abuse of Medicaid and Medicare. If providers are facing ZPIC audits this may be because the auditors believe that the provider may be engaging in fraudulent or abusive billing practices. If abuse or fraud is detected, ZPIC can hand over cases to law enforcement. It is important, if you are facing a ZPIC audit, that you provide evidence to support your billing practices, correct any errors, and substantiate any claims you have made. If a ZPIC audit is found correct, hospitals and health care providers should show that they are taking steps to correct errors. Because a ZPIC audit is so serious, many providers seek the counsel of a Medicare provider appeals attorney. The Heilman Law Group, PA are Medicaid provider appeals attorneys in Jackson, Mississippi who can review your case and help you navigate your audit.
RACs (Recovery Audit Contractors) or MACs (Medicare Administrative Contractors) can both audit Medicare and Medicaid claims. RACs generally look for errors and for high bills and target these areas for audits. MACs can also audit claims and can review payments before they are paid. Being audited by either a MAC or a RAC can be challenging for providers. It can be stressful not knowing when or if you will be paid. CERTs (Comprehensive Error Rate Testing Contractors) work with MACs may randomly sample claims to check for errors. It is important to cooperate with MACs and RACs because failing to do so can either result in delayed payments or referral to ZPICs, which can lead to greater consequences. If you are facing a Medicare or Medicaid audit, a Medicare provider appeals attorney may be able to help you. The Heilman Law Group, PC works with clients who are facing audits to help them get the best possible outcome.
Documentation is incredibly important if you are being audited. How you respond to an audit can sometimes determine the outcome of your Medicaid provider appeal. Also, deadlines to contest audits are often short, and failure to meet them can bar you from later contesting the audit findings. Many companies seek the assistance of Medicare provider appeals lawyers to help them with their appeal and case. The Heilman Law Group, PC understands the competing interests that are at stake during an appeal and can help you negotiate this sometimes complex process.