Attorney For Texas Medicare Prepayment Audits

Texas has been identified as a region where more and more medical providers are being subjected to Medicare prepayment audits. These audits, known as Medicare Zone Program Integrity Contractors audits (ZPIC audits), can cause serious problems for health care businesses if they do not know how to respond.

Attorney Alejandro Mora can advise you on how best to address Medicare prepayment audits. We can counsel you on how to complete these requests and how to put in place practices that will ensure that your first audit is also your last.

Call 512-937-1128 today for a free consultation concerning a Medicare prepayment audit. From our law office in Austin, we serve health care providers in Dallas-Fort Worth, Houston and San Antonio and throughout Texas.

Why Auditors Deny Some Medicare Prepayment Claims

ZPIC audits are confusing and catch many in the health care industry by surprise. There is very little in laws or regulations about these procedures. The first sign that your business may be in trouble generally comes when you get a request for additional documentation from an auditor.

For the most part, claim denials are specific to physicians, facilities and other health care providers who submit them. However, three common reasons for denial include the following billing practices:

  • Lack of medical necessity: Failing to specify an acceptable medical reason for the service or item claimed is sure grounds for denial. We assist our clients with processes to ensure that treatments and services have well-documented applications that qualify as medical necessities.
  • Inappropriate or illegible signatures: Using an affidavit or other standardized ways to log signatures, such as an attestation log, are good ways to avoid denials on this basis.
  • Illegible documentation: Ensuring that your medical reasons, signatures and other pertinent information are legible is critical.

Representing You In Full And Partial Medicare Audits

Recovery audit contractors (RACs) hired by Medicare conduct data mining activities of health care providers. When these data mining activities run across abnormalities, it triggers an audit of Medicare prepayments made to the provider. While the audit is in process, the provider associated with the statistical abnormalities can suffer financial harm while Medicare withholds reimbursement.

You may be subjected to a full or partial Medicare audit:

  • Full Medicare audits: During a full audit, Medicare will not reimburse the provider for any claims until the provider submits information to show the validity of the claims. For those whose practices depend almost entirely on Medicare reimbursement, a full audit can essentially bring cash flow to a standstill. As such, it is vital to contact us as soon as you have been notified of an audit or believe that you will soon receive such a notice.
  • Partial Medicare audits: A partial audit will stop reimbursement for selected types of claims. Although there will still be some form of reimbursement, it still leaves providers with less than full compensation until the audit is complete. We help clients keep the audit process moving so that they can return to their full earning capacity as soon as possible.

The type of audit, either full or partial, can make an enormous difference in these matters, as each type of audit will result in varying amounts of Medicare funds being withheld.

Lawyer Alejandro Mora will work to prevent a full or partial Medicare audit from having an overly adverse effect on your business. He possesses the vast Medicare and audit knowledge required to find efficient solutions that can free you from the audit process and allow Medicare reimbursements to resume.

Some of the services we provide include:

  • Reviewing audit-related documentation and suggesting improvements before you send it to the RAC
  • Conducting internal audits of your Medicare documentation so you are prepared in case of an official audit by a RAC
  • Providing advance planning to decrease the likelihood that you will be subjected to a Medicare prepayment audit in the future

Call 512-937-1128 or contact us by email for more information about Medicare prepayment audits.