![]() What types of documents are requested in the UPIC contractor’s request? Carefully review the nature of the request. Although most UPICs will readily agree to an extension of time, if they only agree to extend the deadline to 30 days, they really aren’t granting the provider anything, are they? When we have objected on behalf of our clients, the UPIC has readily agreed to a due date of not less than 30 days. This is really frustrating in light of the fact that under 42 CFR 420.304(b)(1), a CMS contractor is supposed the health care provider 30 days to submit the documents being requested. Over the last year, a number of CMS contractors have issued requests for documents requiring that the documentation be submitted to the contractor within 15 days. First Signs of a UPIC Audit - Site Visits and Document Requests One UPIC in particular, Qlarant, has been especially active over the last six months in sending out audit letters requesting copies of medical records and other documentation which supports the specific claims being assessed. Now is the time to conduct a “GAP Analysis” of your current practices so that any needed remedial actions can be taken.Ī number of our clients around the country have already received requests for records from the UPIC handling their jurisdiction. Participating providers have an obligation to keep up with and follow all applicable statutory and regulatory requirements associated with Medicare and Medicaid services. ![]() In any event, the consolidation of these program integrity duties is yet another clear indication that the government intends improve its efficiency in scrutinizing questionable Medicare and Medicaid billings. On the positive side, the UPIC program is likely to go a long way towards streamlining the audit process and reducing the number of duplicative audit requests received from competing CMS program integrity contracts. It is therefore essential that all health care providers participating in the Medicare and / or Medicaid programs ensure that they have developed and implemented an effective Compliance Program. As such, each of these UPIC contractors have years of experience supporting the government’s efforts to identify, deter, prevent and reduce fraud, waste and abuse.ĬMS believes that the UPIC program integrity strategy will greatly enhance the ability of the agency to identify aberrant billing patterns and practices, especially those that involve both Medicare and Medicaid claims. CoventBridge (formerly NCI / AdvanceMed) ( Midwestern Jurisdiction): IL, IN, IA, KS, KY, MI, MN, MO, NE, OH and WI).Īt first glance, you will likely note that the virtually none of the awardees are new to the business of “program integrity.” In fact, each of these contractors have previously served as a ZPIC or PSC. ![]() SafeGuard Services, LLC ( Northeastern Jurisdiction): ME, VT, NH, MA, RI, CT, NY, PA, NJ, DE, MD, DC, and the counties of Arlington and Fairfax and the city of Alexandria in Virginia.Safeguard Services LLC ( Southeastern Jurisdiction) AL, FL, GA, NC, PR, SC, TN, U.S.Qlarant Integrity Solutions ( Southwestern Jurisdiction): CO, NM, OK, TX, AR, LA and MS.Qlarant Integrity Solutions ( Western Jurisdiction: AK, AZ, CA, HI, ID, MN, NV, ND, OR, SD, UT, WA, WY, American Samoa, Northern Marianas Islands and Guam).Current List of UPICs Around the CountryĪs of December 2020, the current list of contractors working as UPICs around the country include:
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