If you get a ZPIC demand letter without a record request that means you’ve been the subject of an automatic review. Automatic reviews are implemented in order to detect obvious mistakes in billing. They’re usually done by computer and are typically fairly simple to handle. The good news is, you might not have to do anything further.
However, in order to ensure you address any concerns and requests thoroughly, you’ll want to let an experienced lawyer take a look at your demand letter. Otherwise, here’s a brief explanation of what you can do if you receive a demand letter that is not accompanied by a record request.
Review Your Records for a Mistake
Make sure you fully understand the reason why the claim or claims were flagged in the review. Go back over your own records to look for the mistake. This step is especially important in addressing the demand letter and preventing your business from facing costly consequences. Review your records thoroughly. If you aren’t sure what to look for in reviewing your documentation, consult one of our attorneys.
Find Out Why the Overpayment Was Made
Common reasons why overpayments are flagged in an automatic review include:
- The service provided cannot be covered by Medicare or Medicaid.
- The service is “medically unbelievable,” meaning that it doesn’t make sense from an anatomical standpoint, or is medically unreasonable.
- You have failed to respond to a record request for a previous, complex review in a timely manner.
There could be a number of other reasons an overpayment was made so make sure you track down exactly what might have happened.
Decide Whether You Want to Appeal
Do you want to appeal the findings? Talk to your attorney about whether an appeal is the best decision for you. Appeals can be time-consuming and costly, but having a history of claim denials can make you more vulnerable to future audits.
You’ll need to take corrective action right away to fix your mistake and keep your organization from attracting any more scrutiny. If you are not appealing the decision, pay the overpayment. A payment plan may be possible, or you may be able to get some of the debt forgiven.
Contact Experienced ZPIC Attorneys at Oberheiden & McMurrey, LLP
Getting a ZPIC demand letter can be scary and intimidating, especially if you aren’t sure what to do next. Our attorneys have the experience and knowledge you need to help you navigate the ZPIC audit process, and figure out the best way for you and your business to proceed. Don’t risk making a costly mistake attempting to navigate the process alone, or even worse, ignoring the letter you have received.
To learn more about a ZPIC audit and what you can expect – whether or not documentation is requested – you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.