Defense of Complex Audits
CMS contractors pursue recovery of alleged overpayments through different programs including RAC, ZPIC, and TPE. Commercial carriers use the methods employed by CMS contractors to conduct retroactive audits of paid claims or prepayment review in violation of their contracts. The firm uses its experience to analyze the issues through complex audits. While not always successful, in many cases, the firm recovers offsets, disputes allegations of overpayment, and successfully precludes government and commercial payors from denying claims medical services rendered.