RAC Audit Appeals - ZPIC Audit Appeals - Medicare Extrapolation Defense
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Winning. It's the most important thing we do.
Providers work hard and deserve payment for insuring exceptional care and services to Medicare beneficiaries. Yes, there are rules, but the system of rule-making and implementation is extraordinarily dynamic. The Centers for Medicare and Medicaid Services (CMS) has 10,000s of employees and contractors assisting in changing and enforcing the rules, it is simply impossible for a single provider to keep pace.
Jackson Davis HealthCare is the nation's leading resource for Medicare audit defense and Medicare appeals. Over the past 27 years, we have assisted the nation's leading providers in defending 10,000s of overpayment challenges, winning Medicare appeals cases and performing vital due diligence for acquisitions. Our staff are experts in building appeals and defense cases for a full range of RAC audits, ZPIC audits, MAC audits, OIG audits and USAO audits.
Jackson Davis is the undisputed leader in understanding and synthesizing Medicare rules, regulations and guidance. No one understands Medicare coverage criteria better than we do - and we prove it every day. Simply put, Jackson Davis is on your side and our honesty, knowledge, experience and passion makes us your best partner for developing winning Medicare appeals.
Over the past decade, CMS has ramped up efforts to guarantee the taxpayer that healthcare providers are solely paid for services rendered that (1) meet requirements as originally established within the Social Security Act and subsequent regulations; (2) meet Medicare provider contractual obligations (Conditions of Participation); and (3) meet Medicare coverage criteria.
CMS spent 30 years collecting and analyzing outcomes data from internal audit programs (CERT, HPMP, QIO, etc.) and both Congress and CMS have committed unprecedented resources to enforce evidence-based coverage policies and stop perceived Medicare fraud. In an effort to move-the-bar and collect on overpayments to providers, the federal government is taking aggressive strides to accelerate the acceptance of evidence-based health care and lighten the load of a strained national budget. The modern Medicare auditing effort is both far reaching and technologically advanced. Law enforcement, Medicare Recovery Auditors (RAC Audits), Medicare Administrative Contractors (MAC audits), Zone Program Integrity Contractors (ZPIC Audits), the Office of Inspector General (OIG) and a host of others are coordinating to crack down on and eliminate fraud.
CMS is investing hundreds of millions of dollars to force providers out-of-business and into complying with Medicare rules & regulations. The target? Everyone. In addition to now having thousands of contracted individual Medicare auditors under the CMS umbrella, the government is utilizing leading-edge database technology and integrated business logic to assist in the day-to-day review of millions of electronic Medicare claims for payment. Providers can no longer fly under the radar of the Medicare audit process. If you submit electronic claims for payment, you are instantly being “audited” for the services rendered. The problem? The vast majority of healthcare providers are good people that obey the law and make every effort to adhere to multiple layers of conflicting and seemingly arbitrary Medicare coverage criteria for payment. While for-profit, Medicare audit contractors are building businesses and selling out to the highest bidder, providers are caught in a giant web of never-ending Medicare audits of their services. Hospitals, physicians, home health agencies, hospices, skilled nursing facilities, inpatient rehab facilities, physical therapists and HME suppliers.... all are facing daily challenges of operating under enormous governmental scrutiny and overwhelming paperwork requirements.
Now, more than ever, Medicare contractors are applying subjective opinions and inaccurate criteria in order to insure preconceived outcomes. Great providers are being bankrupted and thousands of people are losing their jobs to unscrupulous auditors that are just trying to make a buck and increase their company's stock price.