Payor Disputes
Disputes with private insurers, Medicare Advantage plans, and Medicaid MCOs over claim denials and recoupments.
Alabama Medicaid Agency Program Integrity Reviews
How the Alabama Medicaid Agency's Program Integrity Division opens reviews, requests records, recoups overpayments, and the fair h…
Compliance Program Remediation After a UPIC Audit Closes
A remediation checklist for the weeks after a UPIC audit closes: root cause review, coding fixes, billing holds, training, and mon…
Home Health Moratoria and Enrollment Screening
A nationwide 2026 moratorium and the 42 CFR 424.518 high-risk screening tier govern how a new home health agency enrolls in Medica…
Home Health Therapy Visits Under Medical Review
Home health therapy claims face RAC, UPIC, and MAC review on three points: skilled versus maintenance care, the 30-day reassessmen…
Connecticut Medicaid Audits by the Department of Social Services
Connecticut DSS Medicaid provider audits run on fixed statutory deadlines, a 36-month lookback, and an extrapolation threshold pro…
North Carolina Medicaid Audits and Program Integrity
North Carolina Medicaid providers get 30 business days to request a reconsideration review and 60 days to petition the Office of A…
Home Health Certifying Physicians: Personal Exposure in an Audit
What a home health certifying physician signs under 42 C.F.R. 424.22, and how an unsupported certification becomes personal civil…
Medicaid Telehealth Audits by State Agencies
State Medicaid agencies audit telehealth claims against place-of-service and modality rules that differ by state, and coding error…
UPIC Findings of Missing Records: When Documentation Cannot Be Found
The duty to produce Medicare records stays with the billing provider under 42 CFR 424.516(f), not a former vendor or closed EHR sy…