Reimbursement Protection and Success

Are you a wound care provider seeking guidance on CMS (Centers for Medicare & Medicaid Services) ambiguous CTP policies while fortifying the sustainability of your practice from costly audits?

Have you been the focus of a Uniform Program Integrity Contractor (UPIC) audit by CoventBridge, Qlarant or SafeGuard Services or are concerned you may become a target? Your search ends here. Engage Health is your dedicated partner, poised to equip you with the expertise, experience, and exclusive insights essential to protect your practice and flourish in today’s dynamic healthcare landscape.

See How Engage Can Help

Experienced: Our team has been involved in millions of reviews for government and commercial health plans.
Simple: No need to worry about complex or cumbersome implementations. Our solutions are easily implemented.

Strategic: We know how to approach denials in a way that isn’t an all or nothing proposition.
Flexible: Engage works with you to develop a program that meets your operational and financial goals to drive high ROIs.

Contact Engage to embark on your journey to audit resilience and success, tailored exclusively for wound care providers.

Why Choose Engage Health?

Wound Care Expertise: We understand the unique challenges faced by wound care providers. Our team is well-versed in the intricacies of skin substitutes and Cellular and Tissue-based Products (CTPs), ensuring that you receive specialized guidance and protection.

Audit Preparedness: Engage Health is your partner in audit readiness. We help you proactively prepare for audits, ensuring that your documentation, coding, and claims are in compliance with CMS requirements.

Appeal Success: If you encounter audit denials, our experts know how to navigate the appeals process effectively. We have a track record of achieving positive outcomes for providers facing audit investigations.

Insider Insights: Our team includes individuals who have worked directly with CMS, providing us with insider knowledge of CMS procedures and priorities. We know the gravity of audit outcomes and will work tirelessly to protect your practice.

Secure Your Wound Care Practice’s Future

Do not leave the fate of your wound care practice to chance. Connect with Engage Health today and gain access to the audit protection and support that can make all the difference. Together, we will secure your practice’s future, ensuring your continued success.

What is the Uniform Program Integrity Contractor?

UPIC contractors play a crucial role in the oversight and integrity of the Medicare and Medicaid programs in the United States. UPICs are contractors, such as SafeGuard Services, ConventBridge and Qlarant, hired by the Centers for Medicare & Medicaid Services (CMS) to conduct audits, investigations, and reviews to identify and prevent fraud, waste, and abuse within these healthcare programs. The primary goal of UPICs is to protect the integrity of Medicare and Medicaid by ensuring that healthcare providers are billing accurately and in compliance with program regulations.

Here’s how UPICs can affect healthcare providers and the impact of their audits:

Audit Selection: UPICs select healthcare providers for audits through various methods, including data analysis, tips from beneficiaries, and referrals from other contractors. Providers may be chosen for audits based on specific risk factors, billing patterns, or allegations of fraudulent activity.

Audit Process: When a provider is audited by a UPIC, they are required to provide documentation and evidence to support the services billed to Medicare and Medicaid. UPICs will review these documents to determine if the services were medically necessary and appropriately billed.

FutureProof Your Wound Care Practice for Reimbursement Protection and Success | Engage Health Solutions

Potential Impact: UPIC audits can have significant financial and operational consequences for healthcare providers. If a UPIC identifies discrepancies or issues with a provider’s billing practices, it may result in:

Payment Suspensions: Pending the outcome of the audit, CMS may suspend payments to the provider. This can create cash flow challenges and financial strain on the practice.
Overpayment Requests: UPICs may request that providers repay any overpayments identified during the audit. These repayments can be substantial and can impact a provider’s financial stability.
Extrapolation: If UPICs find issues with a sample of claims, they may extrapolate those findings to the entire claims population. This can lead to larger repayment demands.
Self-Assessment Obligations: Providers found in violation of Medicare and Medicaid regulations may be required to self-assess and repay amounts related to non-compliance for up to six years.
Appeal Process: Providers have the right to appeal UPIC audit findings they disagree with. The appeal process can be complex and time-consuming but provides an avenue to challenge adverse audit determinations.
Provider Education and Compliance: In addition to audits, UPICs may offer education and training to providers to help them understand and comply with program requirements. Providers can proactively seek this assistance to improve their compliance.
Preventive Measures: Given the potential financial and operational impact of UPIC audits, providers are increasingly focusing on preventive measures to avoid audits altogether. This includes robust compliance programs, accurate documentation, and ongoing staff training.

In summary, UPIC contractors play a critical role in identifying and preventing fraud, waste, and abuse within Medicare and Medicaid. Their audits can have a significant impact on healthcare providers, affecting both financial stability and operational efficiency. Providers should be proactive in understanding program requirements, maintaining accurate documentation, and seeking assistance when necessary to reduce the risk of UPIC audits and denials.

Partner with Engage Health for UPIC issues.

Engage Health is your trusted partner in CMS UPIC program support for a multitude of reasons:

Extensive CMS Audit Experience: Our seasoned team brings extensive experience in dealing with CMS audits. We understand the intricate reasons behind audits, know how to navigate the appeals process successfully, and possess an in-depth grasp of the entire appeals procedure.

Focused Audit and Denial Management: At Engage Health, we are dedicated to managing audits and denials. Our collaborative efforts with providers nationwide have provided us with invaluable experience, which we are eager to share with your team.

Insider Knowledge of CMS: Many of our team members have worked directly for and with CMS, providing us with a unique insider’s perspective on the paramount importance of passing audits—an aspect that providers may sometimes underestimate.

Our Mission: Your Protection and Success

At Engage Health, our mission is clear: to empower healthcare providers like you with the knowledge and expertise needed to protect your practice, secure your reimbursements, and thrive in today’s ever-changing healthcare landscape.

Connect Today and Secure Your Future

Do not leave your practice’s fate to chance. Failing a Uniform Program Integrity Contractor (UPIC) audit can lead to severe consequences. Connect with Engage Health today and discover how our extensive CMS UPIC program support can be tailored to meet your specific needs. We are here to support you every step of the way, ensuring that your practice remains resilient and prosperous.