Medicare Audit

Have a Medicare audit coming up and you have questions? That’s understandable as a lot has changed in the last couple of years with this particular area, and throughout the entire industry. This is where having an experience legal team to watch your affairs can be extremely beneficial. They understand the ins and outs of these matters and know exactly what it will take to get you a favorable outcome and make sure that other problems do not come up. It’s hard to run a company in the medical field and it’s even tougher to do it without dependable legal counsel to help you along the way.

One of the ways you can determine which law firm is the right one for you is by looking at what that team offers you throughout the year besides great service. For example, we understand that our services may not be needed every day but there are still questions you need answered and areas of this field you want more clarification on. That’s why we post weekly blogs which are written by lawyers who specialize in a particular area as well as hold monthly webinars which are free and talk about the latest news and how it can impact your business.

The Florida Healthcare Law Firm routinely represents physicians, medical groups, home health agencies and skilled nursing facilities in preparing for and responding to Medicare audits and on site visits for program participants. Our team will take the time to do a full diagnostic on your practice or healthcare business to prepare you for any follow-up activity in your Medicare Audit before we respond. Our goal is to keep your business flowing in the midst of potential Medicare audit payment suspension, Medicare appeals that may be necessary and prevent any additional exposure resulting from the Medicare audit. We provide representation on denied claims, false claims or overutilization of services and challenge overpayment demands and allegations of fraudulent billing. It is imperative for providers to engage counsel a respond within the first 30 days of receiving a demand letter so that they can preserve the most advantageous options and potential Medicare audit results for themselves.

A Medicare Administrative Contractor (MAC) is responsible for reviewing and paying Medicare claims for a specific geographic region. They also take on the responsibility for flagging overpayments and processing provider appeals. Medicare Administrative Contractors will perform a detailed data review to identify provider billing patterns, often using a small sample of claims. The goal is of course to identify enough data to move forward with raising a red flag to delve deeper in to the provider’s billing policies and procedures. This, along with many other strategies including Postpayment Review, Probe samples, Medical Review Program vary in severity from minor to moderate and on to significant. All of these will results in a provider being notified in writing and requesting more information.

Providers should keep in mind that a small audit sample of, say 40 claims, with a 25% denial decision can result in a full denial of all claims from that period. Hence, the extrapolated overpayment can result in millions of dollars of overpayment demands which may effectively shut down a provider’s entire business. Therefore, engaging experienced counsel at the outset of any Medicare audit is key to not only getting through the Medicare audit but also continuing on as a successful business. Business owners faced with a Medicare audit will want to take a quick inventory of their own compliance to ensure minimal risks and exposures.

At The Florida Healthcare Law Firm our goal is to make sure that you have all the assistance you need when it comes to a Medicare audit. However, that doesn’t mean we aren’t hear to help with other areas as our blogs and webinars have helped hundreds of business owners just like you to stay up on the latest trends in the medical field. Interested in finding out more? Feel free to browse our site where you can sign up for the webinar, read our blogs or if you have any other questions you can always contact us today to schedule an appointment.

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