Medicare, Recovery Auditors/RAC, Medicaid, and Private Payor Audit Defense and Appeals

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  • Medicare, Recovery Auditors/RAC, and Medicaid Audit Defense and Appeals
  • Participation and Departicipation with Third Party Payors
  • Private Payor Audit Defense and Appeals (e.g., BCBS audits, Delta Dental audits, etc.)
  • Program Safeguard Contractor (PSC) and Zone Program Integrity Contractor (ZPIC) Audit Defense and Appeals
  • Provider-Payor Contracting
  • Reimbursement and Overpayment Issues

Providers and suppliers are experiencing a time of unprecedented auditing activity. Medicare, Medicaid and third party payors are engaging in significant auditing activity and are engaging the services of outside contractors to assist in their claim reviews. Providers and suppliers should act now to prepare for increased claims scrutiny. Medicare’s Recovery Audit Contractor (RAC) program is now operational nationwide. It is essential that Medicare providers and suppliers understand the RAC program, and initiate and/or update compliance efforts to prepare for the increased claims scrutiny brought by the RACs.

Providers and suppliers should be aware that the RAC auditing activity is done in conjunction with other existing Medicare auditing activity. Therefore, providers and suppliers may still see audits conducted by the Medicare Affiliated Contractors (i.e., Carriers and Fiscal Intermediaries) and Zone Program Integrity Contractors (i.e., Program Safeguard Contractors). Providers and suppliers are experiencing increasing audit activity by all types of Medicare contractors, leading to an ongoing pursuit by business leaders to secure representation from the most knowledgeable RAC attorneys.

The RAC attorneys of The Health Law Partners, P.C. have years of experience successfully appealing all types of claim denials, including Medicare and RAC claim denials. Our RAC attorneys not only understand the variety of steps involved in a recovery audit, but also best practices for providers and suppliers to incorporate within their ongoing business efforts.

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