When you accept payment from a government program such as Medicare or Medicaid, it’s important to be compliant. Since you are receiving taxpayer dollars, there are real rules in place to ensure that everyone’s acting appropriately. These agencies want to see that providers bill accurately, and private government contractors known as UPICs work to root our fraud, waste, and abuse. A UPIC investigation is not something to take lightly, either.
Our helpful team at Medical Auditing Solutions understands how to navigate the complex world of government payers. Unified Program Integrity Contractors have ramped up their investigation efforts after stepping back during the pandemic, and the Centers for Medicare & Medicaid Services have shown that they’re putting their foot on the gas. A UPIC audit is more targeted, invasive, and frequent than it was just five years ago, so talk with a trusted, expert team about ways to avoid them. And if you’ve received notification that you’re being targeted, call our office to talk about your next steps. We will work with your attorney, which is highly recommended with this contractor.
There are real consequences of a UPIC audit. To find out more about what they look for, call Medical Auditing Solutions.
Data Analytics Drives The Uptick
If you’ve noticed more activity by payers, you are not alone. With the advent of advanced data analytics software, they simply have more tools at their disposal to identify problems. UPICs, in particular, are using this technology to scour massive Medicare and Medicaid databases. They’re able to spot coding outliers, spikes in paid amounts, and more in an instant. Patient complaints that they didn’t receive the service or product can get your billing privileges suspended.
While most providers certainly do their best to stay compliant, it’s always possible to make a mistake. Our team works with offices just like yours to make sure that they’ve got the tools and training they need. If you’ve got questions about the technology that payers and UPICs are using, let’s talk further.
Increased Scrutiny Affects Specialties Differently
Many medical offices are at risk of a UPIC audit, but some fields are targeted more than others. Home health and hospice agencies need to document reasons for long inpatient stays, life expectancy, and extensive treatment, so recent reports show that they are seeing increased scrutiny.
DME (Durable Medical Equipment) suppliers are also having a tougher time this year, too. This area is one that UPICs have been checking out in great detail, as insulin pumps and more offer high rates of reimbursement. If you use a third-party company to generate your leads, or if you rely on telehealth services to find people, investigators might look deeper at your processes.
Uncover UPICs With Medical Auditing Solutions
They’re taking a deeper look than ever before. When you need to know more about UPIC audits, reach out to Medical Auditing Solutions and My DME Billing at (972) 459-1508.