They get a percent of recovery, but most contractors don't you know, get that. And so they're thinking about the RACS, who there was sort of like a contingency. Aren't aren't these contractors incentivized to deny claims? Right. And it may be a place to start, Bryan, because I feel like we get this question all the time. This is a very stirring title Bryan about and what we're going to be talking about here which is you know a fancy way of saying the OIG came out with a very recent report about UPIC activity and how is it effective and what kinds of things are they doing. The UPIC report card, the OIG's evaluation of the UPICs provides insight into the future of hospice audit. Hello and welcome to Hospice Insights, The Law and Beyond where we connect you to what matters in the ever changing world of hospice and palliative care. Further, a provider should carefully document all communications with the UPIC and all documentation that it submits to the UPIC, in the event that the UPIC claims it lost or did not receive documents from the provider.įor over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation.This transcript was auto-generated using Adobe Premiere Pro. Any claims denied by the UPIC should be timely appealed and contested through the Medicare claims appeal process. Therefore, providers should not discount even small UPIC audits. At this point, it may be too late to appeal the results of the earlier probe audits, leaving the provider in the unenviable position of defending itself when CMS thinks the results of the probe audits are set in stone. The UPIC may also persuade the Centers for Medicare & Medicaid Services (CMS) to revoke the provider’s Medicare billing privileges because the UPIC’s probe audits have made it appear as though the provider has a pattern of submitting claims that do not meet Medicare requirements. However, UPICs often use the results of these small probe audits to jump to the conclusion that the provider is committing fraud and, seemingly out of nowhere, suspend the provider’s Medicare payments. These small probe audits may at first appear to be not worth defending or appealing. Often UPIC audits begin as small probe audits, possible only a dozen claims valued at a few thousand dollars. It may utilize records requests, onsite reviews at the place of business of the provider or supplier, or interviews of employees of the provider or supplier. ![]() Once a UPIC initiates an investigation, it has many tools at its disposal. The UPICs may also receive referrals from other agencies and from outside sources, such as news media, interviews, or beneficiary complaints. ![]() This means that providers with unusual billing patters or high utilization are inherently more susceptible to UPIC investigations, even if these billing practices are for entirely legitimate reasons, such as a particular patient population. The UPICs are authorized to use analysis of claims data to identify potential billing irregularities or suspected fraud, and this is the most frequent source of a UPIC investigation. Even a UPIC audit for a relatively small number of claims or a relatively small dollar value should be treated as a significant investigation.Ī UPIC may initiate an investigation based on several types of leads. ![]() The primary goal of the UPICs is to identify potential fraud however, they are often quick to accuse providers of significant fraud and bring devastating consequences to providers without giving the providers an opportunity to respond. A UPIC (Unified Program Integrity Contractor) is a type of Medicare contractor that combines several program integrity functions that were previously handled by different entities. One of the most destructive types of audits that a Medicare provider can suffer from a Medicare contractor is a UPIC audit.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |