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In the current regulatory environment, healthcare providers are under greater scrutiny than ever before. While the Centers for Medicare and Medicaid Services (CMS) always had the right to review and deny services deemed to be inappropriately billed, health care reform and other recent initiatives have added even more programs and contractors that will be looking at providers' claims. We know that receiving notice of an alleged 'overpayment' from one of CMS' contractors or another payor can be a stressful experience for healthcare providers. While do not necessarily need an attorney to appeal claims, the can be confusing and burdensome to those who are unfamiliar with it.

There are legal and procedural arguments that can be advanced most effectively by attorneys with experience in this area. At Wachler & Associates, we devote a substantial portion of our practice to handling appeals on behalf of Medicare providers. We are intimately familiar with the process. We work on Medicare and other payor appeals daily and can navigate the system for you, or help you to navigate through the system.

We have successfully defended thousands of,, and audits on behalf of healthcare entities, providers and suppliers nationwide. We assist providers in various ways, from 'full service' handling of all levels of the appeals submissions, to assisting with the drafting of templates, position papers or briefs for healthcare providers who want to handle the appeals on their own. RACs are companies contracted by CMS to identify Medicare overpayments and underpayments and return Medicare overpayments to the Medicare Trust Funds.

RACs review claims submitted in an attempt to identify improper payments. Although tasked to identify both overpayments and underpayments, RACs are highly motivated to identify improper payments, as RACs are compensated on a contingency-fee basis. Experience has shown us that RACs tend to be very zealous and identify overpayments far more frequently than underpayments. The RAC program is also being expanded to include Medicaid claims, Medicare Advantage (Part C) and Prescription Drug plans (Part D).

Medicare Administrative Contractors or MACs have taken the place of the former carriers and fiscal intermediaries and are contracted by CMS for many reasons. The MACs have many functions, such as handling enrollment issues and claims processing. They are also responsible for addressing billing errors involving services that are not covered or not coded correctly. MACs can identify healthcare providers who they deem to be 'outliers' through data analysis and often conduct probe audits on select providers. MACs review claims to determine proper payment amounts and adjust or deny payments if the reviewers find the services to be not reasonable or medically necessary, or find that the claims submitted do not properly reflect the services furnished.

If the MACs find healthcare providers whose claims have high error rates, they can put the providers on additional post-payment or prepayment reviews. Zone Program Integrity Contractors or ZPICs are responsible for implementing the Medicare Benefit Integrity program, which involves the identification of suspected fraud.

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This program is in contrast to the MACs' task discussed above, which is primarily concerned with preventing and identifying errors. ZPICs use a variety of proactive and reactive techniques to identify and address any potentially fraudulent billing practices. These techniques include pre-payment review and additional development requests (ADRs), which can be detrimental for a healthcare provider because the provider must submit documentation and oftentimes complete the appeals process before being paid.

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ZPICs may receive referrals from other contractors, such as RACs or MACs or they may conduct their own data analysis to identify potential fraud. Leads also may be identified using a variety of contractor functions including claims processing, data mining, audit and reimbursement, appeals, medical review, and enrollment. Medicare's Targeted Probe and Educate (TPE) program authorizes Medicare Administrative Contractors (MACs) to conduct Medicare audits of providers and suppliers with billing practices, utilization rates, or claim error rates that vary from their peers. TPE audits also target Medicare providers and suppliers that bill for services or items with high national error rates. Following the successful TPE audit pilot program, which was limited to home health care claims and hospital inpatient admissions, CMS authorized MACs to perform TPE review of all types of Medicare providers for all types of services and items billed to Medicare.