Payor Disputes
Disputes with private insurers, Medicare Advantage plans, and Medicaid MCOs over claim denials and recoupments.
UPIC Audits of Home Health Agencies
UPIC audits of home health agencies target homebound documentation, face-to-face encounter timing, and plan-of-care defects under…
UPIC Audits of DME Suppliers
UPIC audits of DME suppliers turn on the order chain: standard written orders, proof of delivery, and the CMS supplier standards u…
Remote Patient Monitoring Medicare Audits
CMS device-day thresholds, interactive communication rules, and OIG enrollment-volume scrutiny are driving a new wave of Medicare…
Self-Disclosing a Medicare Overpayment
Physicians who identify a Medicare overpayment can choose a straight refund, the OIG protocol, or the CMS SRDP, each carrying diff…
UPIC Audits of Genetic Testing Providers
UPIC audits of genetic testing providers focus on cancer genomic panel necessity, telemarketing-driven physician orders, and kickb…
UPIC Audits of Behavioral Health Providers
UPICs are expanding fraud, waste, and abuse review of behavioral health billing, from CPT 90853 group therapy overuse to IOP and P…
Physical Therapy Medicare Audits and the Therapy Threshold
CMS raised the 2026 KX modifier threshold to $2,480, but audit risk now turns on medical necessity, maintenance therapy, and note…
Provider-Based Billing and Medicare Audit Exposure
Provider-based status under 42 CFR 413.65 controls whether a hospital facility fee survives audit, and a 2026 federal mandate rais…
UPIC Audits of Clinical Laboratories
UPIC audits of clinical laboratories target genetic test billing, standing orders, and toxicology panels lacking individualized me…