Audit Appeals & Defense
Repayment demand? Build a solid appeal strategy
Civil Investigative Demand, Whistleblower (qui Tam), TPE, MAC, RAC, SIU, SMRC, Commerical, or CERT Audit UPIC Investigation, False Claims Act, or Healthcare Fraud Statue Case
Has your practice received a demand letter for recoupment of overpayment from a Medicare audit or a private payor? If so, getting your repayment drastically reduced or eliminated entirely is your top priority.
Government agencies, payer demands for refunds, and pre-payment reviews are escalating to levels we have never experienced. If you received a demand letter for overpayment refund, the time to act is now! Do not wait and do not lose valuable time!
DoctorsManagement gives you access to experts in Medicare Appeal, OIG Regulatory Compliance, Audit Extrapolation Defense, CMS Medical Necessity, and Clinical Documentation Reviews.
- We help protect healthcare providers like you from recoupments based on auto-denials, auto-down coding of claims, and over-aggressive and often flawed audit findings
- Our team of litigation and appeal experts includes regulatory compliance professionals, dual-certified auditors and coders, economists, statisticians, data analysis, and clinical documentation experts to integrate into your defense team seamlessly.
- We work seamlessly as an expert witness part of your defense team
CMS (Centers for Medicare & Medicaid Services) UPICS (Unified Program Integrity Contractors ) are in high gear trying to catch up on audit backlogs following the Public Health Emergency. TPE, MAC (Medicare Administrative Contractor), OIG (Office of Inspector General), RAC (Recovery Audit Contractor), MIC, CERT, and SIU audits are also in full swing.
With the massive increase in potential targets thanks to the enormous surge between 2020 and 2021, telehealth services and patchwork of COVID-19 waivers that only applied during the Public Health Emergency, there has been a significant increase in audits and aggressiveness.
We’ve worked incredibly hard to ensure that we build rock-solid defense strategies against unsubstantiated medical audits and we have A PROVEN HISTORY OF SUCCESSFUL AUDIT APPEALS
- 7 Count Indictment reduced to 1 count of a Class A Misdemeanor
- 22 Count Indictment client found innocent on the 11 counts our experts testified on
- Between 2020 and 2021, our team of experts eliminated more than $20 million in commercial and government payer demand for refunds
- $11 million Medicare Refund Demand – Reduced to $3,000 and Payment Suspension Lifted
- $14 million Medicare Refund Demand – Reduced to $233
- Provider Serviced with 125-Year License Suspension – Case Dismissed & Provider Reinstated
A winning strategy includes expert auditors
A winning strategy begins with a winning team! Collaboration between the client and our team members is crucial! You must have a sound defense strategy with experienced auditors who possess a deep understanding of the appeal process. DoctorsManagement provides access to a team of experts in auditing, coding and documentation, audit appeal defense, medical necessity, and regulatory compliance.
Unbiased fact over interpretation
Guidelines are just that, guidelines… They are often convoluted and confusing and written to benefit the payors! Understanding what drives a level of service, what is required to support “medical necessity” and how to defend clinical judgment is critical to the defensibility of your claims! Don’t take unnecessary risks by hiring an unknown commodity. Our team has extensive experience in working with the OIG, DOJ, U.S. Attorney’s Office, CMS, and Commercial payors at the highest-levels.