A Guide to Responding to a Medicare Additional Documentation Request (ADR)
If your practice just received a letter labeled “Additional Documentation Request,” you’re not alone — and you’re not necessarily in trouble yet. An ADR is one of the most common tools Medicare contractors use to review whether a claim was billed correctly. But how you respond in the coming weeks can determine whether that claim […]
What Is a TPE Audit? Understanding Targeted Probe and Educate Reviews
Pursuant to the Medicare Program Integrity Manual (Pub. 100-08), Chapter 3, Section 3.2.5, participating providers who fail to achieve acceptable error rates during Targeted Probe and Educate (TPE) audits may be subjected to 100 percent prepayment review, extrapolation, or referral to a Unified Program Integrity Contractor (UPIC) for further administrative action by CMS or its […]
Chronic Care Management Billing Protocols – a Guide to Challenging DOJ Audit Data
Chronic Car Management is In the DOJ Spotlight. Explore Our Guide to Defending Your CCM Practice During a Healthcare Audit.
MAC Audits vs. UPIC Audits: What Medical Professionals Need to Know
Medicare’s program integrity framework relies on multiple layers of auditing activity. For most providers, the two audit types most likely to affect day-to-day operations are those conducted by Medicare Administrative Contractors (MACs) and Unified Program Integrity Contractors (UPICs). Though both are federal audit mechanisms operating under the authority of the Centers for Medicare & Medicaid […]
UPIC Audits Guide for Healthcare Providers
A UPIC audit is an investigation focused on uncovering healthcare fraud. From handling unannounced site visits to understanding the dangers of statistical extrapolation, this guide details the critical steps you must take to protect your practice from payment suspensions and federal prosecution.