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Medicare and Medicaid Audit Appeals Lawyers

Raiser & Kenniff, PC, is one of the top rated law firms in the country when it comes to medicare, and medicaid, audit appeals.If you’re preparing for an audit, or if you’ve been recently audited for medicare and medicaid billing/coding practices, then you probably want a second opinion on options you may have. There’s an enormous push by the government to recoup money for fraud, waste, and abuse. Audits by medicaid and medicare contractors are on the rise. The audits are used to target providers who bill/code for services not rendered, or for abuse/waste of services. As a result, you’re likely to need the help of a medicare audit appeals attorney to help.

The audits are designed to find overpayments of claims, or fraud. Often, many government auditors make mistakes when conducting an audit – which can result in negative actions being taken against you when it’s not your fault. It’s highly recommended that providers never accept an overpayment. When possible, it’s advantageous to return overpayments. In all cases, providers have the right to question the audit, and have th eright to appeal the audit as well. In all cases, you should consult a medicare audit appeals lawyer to help. Raiser & Kenniff handles all forms of medicare and medicaid audits, or other private insurance company coding, compliance, and fraud issues. We can help you respond to allegations of overpayment, fraud, or anything else – that may come from a medicare or medicaid contractor.

Our law firm handles all hearings, appearances, and due diligence that needs to be done. We help ensure that you have an opportunity to have your side of the story told, and that any allegations made against you are clarified and resolved. We undertake all negotiations on your behalf, in order to reduce the amount of money you owe in fines and in reimbursements for over-billing.

Medicare – Medicaid Contractors – ZAC, MAC, ZPIC, MIC

Businesses who are facing a medicare or medicaid audit should immediately try to get the help of a qualified attorney upon any request from a RAC, MAC, ZPIC, MIC, or any other program integrity agency. It’s possible to avoid lengthy legal battles by speaking to a qualified medicaid/medicare appeals audit appeals attorney. If you have a lawyer, medicare/medicaid contractors will respond and act differently. Often, providers give up excessive information when explaining or stating what they believe the problem is. Unfortunately, audit contractors use the providers words against the provider. Contractors will often take words out of context, and use them to prove your guilty. It’s important to know that some legal rights can be waived, if you don’t raise them immediately. That’s why having a Medicaid/medicare appeals audit lawyer is crucial. Most providers are unaware of the fact that RAC’s work on a contingency fee basis – which means their financial security relies on proving you are at fault. They won’t play fair. It’s not in their financial interest. Their job is to audit and examine medicare and medicaid claims filed by all types of providers. If you’re being audited by a RAC, remember that they are a private company – and will review all of your billing and coding errors, in addition to looking for accounting mistakes, and inaccuracies, or fraud. RAC’s review claims on a post-payment basis. RAC’s are extremely aggressive in their attempt to recoup money.

RACs examine all of your provider claims in order to discover overpayments, or anything that is a sign of potential fraudulent billing of medicare or medicaid. At Raiser & Kenniff, our medicare audit appeals attorneys will help preserve your rights, and ensure the auditor’s are complying with the rules and guidelines. We help you comply with the auditor’s requests in a manner that doesn’t leave you blindsided.

Medicare Overpayment Appeals Lawyers

Losing an overpayment appeal is devastating. Most overpayment determinations involve huge amounts of money. We understand how devastating it can be, and we do everything in our power to help you. We understand how important it is to address the audit facing your business. We are intimately familiar with the audit process, and this enables us to help understand and respond to all disputes your facing.

You’re likely, at some point in the future, to receive medicare or medicaid payments that result from a mistake, or a billing error. Often, overpayments happen due to mistakes with the amount paid, or the services billed for by the provider. This mistake, or error, in billing/coding can be resolved by paying back the money – or making future adjustments in which codes you use to bill. In our medicare audit appeals attorneys opinion, the issue arises when a provider is unaware of the overpayment, or has a coding issue which goes uncorrected for a long time, resulting in an enormous overpayment. This overpayment claim can trigger a larger audit of your business. It can be difficult to pay back the overpayment. In addition, it can trigger a fraud investigation.

Appeals Process
We help clients by representing them in the overpayment appeals process. We help you with the appeals process, from beginning to end. We help you gather and find all the evidence necessary to show your claim is true. We are experienced, when it comes to dealing with all types of administrative appeals processes. No matter what stage of the process you’re at, we can step in and take over. We work with you through the entire process. We review every piece of data, and hire experts in order to support your case. We understand how crucial it is to dispute any, and all, errors by RAC contractors.

Assertive Appeals
After an audit there’s a chance you might be ordered to repay the Medicare or Medicaid claims that were deemed as illegitimately paid. We will help guide you through the appeals process in order to avoid wrongful reimbursement of funds. We help avoid any unnecessary expenses that come from the overpayment. Whether you want to appeal an overpayment claim by the RAC, or want to negotiate a payment arrangement – we can help. We understand the complex healthcare industry. With ARRA and PPACA, we have a thorough understanding of the large amount of laws that you must be in compliance with. We can help you avoid sanctions and prosecution by being diligent, and advising you of all issues.

How To Approach Your Medicaid Audit

There may come a time when a health care provider will receive a Medicaid Program audit notice. Everything requested needs to be correctly provided when responding to the notice. These types of audits are an attempt to identify any problematic legal issues that could be present within a medical program. Response to the questionnaires must be accurate. All medical records provided need to be organized, easy to understand, legible, and complete.

Medicaid Formula
The audit formula utilized by Medicaid is designed to calculate any and all overpayment amounts. A positive audit may avoid any type of penalty assessment or repayment requirement by Medicaid. It’s important to realize if an audit results in a demand for overpayment, it is still possible to negotiate the results. An acceptable repayment schedule or settlement may be able to be reached.

Audit Notification
When a medical program is being audited by Medicaid, they will receive a notice of the audit from an auditing agency. The agency will provide a list of patients for their sample. Up to 50 patient’s records could be requested for the audit. The audit notification will also come with a questionnaire that needs to be completed. A Certification of Completeness of Records form will also be provided. It will need to be completed and returned with copies of the requested patient records. It’s important to understand the due date on the form. This date isn’t the last day patient records can be mailed. This is the date the records must be with the auditing agency.

Review Claims
Once an audit request is received, it’s important to carefully review all the records that will be submitted to Medicaid. A complete patient record needs to be provided. It can’t be just parts of the from the time requested by the audit. Other physician records used as history, consultant reports, hospital reports and more should all be included. Physicians orders, history questionnaires, results of physicals and more are essential parts of a medical record for auditing purposes.

Explanation
It is important to review the requested patient files prior to submission and address any possible issues. When issues are identified, it’s recommended the medical organization prepare a separate explanation. This should be submitted with the requested file. Doing this can help an audit reviewer assess if there is an actual issue. All explanations submitted with files should be clearly labeled. This will avoid any possible confusion about it being part of the patient’s actual medical record.

Treatment
Should a medical organization take X-rays, or use any type of diagnostic study, or examination for treatment purposes, this also needs to be included with the patient’s record. The auditing agency may accept a patient’s X-rays, diagnostic studies and more on a compact disc.

Uncommon Items
It’s also important to include an explanation of any uncommon abbreviations used in notes or with other parts of the patient’s file. It is also a good idea to include an explanation of any clinical practice or other supporting documents so that all medical procedures and billing procedures are easily understood.

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