Acting through its contractors, the Centers for Medicare and Medicaid Services (CMS) continues its robust auditing of healthcare providers and suppliers (collectively, providers) receiving reimbursement from Medicare and Medicaid. This activity shows no signs of slowing down and may even increase as the end of the COVID-19 public health emergency declaration nears. Actions include Targeted Probe & Educate (TPE) Program audits, Unified Program Integrity Contractor (UPIC) audits, Supplemental Medical Review Contractor (SMRC) audits, and Comprehensive Error Rate Testing (CERT) audits. Understanding the requirements and focus of the most common audit types can decrease the administrative burden and costs on providers when inevitably faced with an audit.
When adverse results occur, CMS and its contractors have powerful tools to recoup overpayments and address program integrity concerns in connection with adverse audit results. Appeals of adverse audit results allow providers to receive payment for previously denied claims and, if extrapolation is used, have the potential to significantly lower damages amounts. Successful appeals also reduce the audit error rate, which is critical as past audit results often drive the government’s future audit targets. Because each level of the appeals process has varying deadlines and requirements, it is important for providers to review and understand the appeal requirements as soon as an adverse decision is received to ensure that all appeal rights are preserved.
Based on their extensive experience assisting providers with responding to CMS audits and appealing audit results, our speakers will discuss the current audit landscape, risks, and best practices related to CMS audits that can be essential for a provider’s business in a webinar on Wednesday, March 8 from 12 – 1:30 p.m. CT. Please click here to register.
Who Should Attend?
- In-house legal counsel.
- Finance department leaders.
- Compliance officers and analysts.
- Reimbursement and revenue cycle personnel.
- Healthcare executives, principals and other senior leadership.
The webinar is pending approval for 1.5 hours of General Tennessee CLE credit. Certificate of completion and other necessary application forms will be provided for use in other jurisdictions.
Submit questions for presenters during registration. For more information, please contact our Healthcare team.