![]() ![]() There are five stages of appeal for unfavorable audit determinations. Once a claim has been denied following an audit, or worse yet, your practice is accused of Medicare fraud, you have the right to appeal the decision and challenge the audit findings. What Happens in the UPIC Audit Appeals Process? Dealing with this type of audit requires experienced legal counsel, as it is often seen as dealing with the highest level of scrutiny. CMS will instigate a UPIC audit only when the agency suspects fraud, waste, or abuse at a healthcare or medical facility.Ī UPIC auditor may request medical records, conduct patient and employee interviews, make in-person site visits, analyze data and error rates, and refer cases of suspected Medicare fraud to the Office of Inspector General (OIG). UPIC audits are not randomly assigned to test compliance rather, they are focused and targeted investigations intended to collect evidence and documentation of suspected irregularities. ![]() The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, has developed a host of resources over the years to combat fraud and safeguard the integrity of Medicare, including a nationwide network of Unified Program Integrity Contractors (UPIC).
0 Comments
Leave a Reply. |