If you are a dental practice that accepts Medicaid, then you need to be aware. UPIC (Unified Program Integrity Contractors) are being used to specifically target dental claims to try to root out fraud, waste, and abuse. UPIC audits signal a federal investigation, so it’s essential to know how to navigate their needs. Should they find problems with your claims, they could ask for major repayments or even potentially spur a criminal case. It’s important to be compliant, especially when Medicaid is involved. The contractor has an exceptional amount of power to recommend suspending or putting providers on prepayment audit. All audits are serious but the actions prior to appeal with this group can be significant.
When you need to know more about UPIC audits, talk to Angela Miller-Leathers at Dental Auditing Solutions. Our office works hard to help dental providers and oral surgeons in your situation, and we understand your next steps. If your claims have been flagged by a UPIC team, or if you’re just looking to learn more to stay consistently compliant, we’re here for you. Schedule a time to talk about your office’s needs, from navigating audits to quality compliance training that gives you the opportunity to avoid one.
Dental practices are not immune from a UPIC audit. If you’ve been notified, talk to Dental Auditing Solutions about your next steps.
UPIC Audits Are Often Targeted
This means that they might already suspect a pattern of improper or incomplete billing. A UPIC (Unified Program Integrity Contractor) begins with a specific target in mind, rather than through a randomized system or a sweep. Instead, these private companies work with CMS, and they’ve got access to the Integrated Data Repository (IDR). It has access to almost all Medicare and Medicaid claims. The UPIC were supposed to audit Medicaid claims since inception; however, within the last year CMS made public they had not been doing this. Therefore, expect more Medicaid claim audits.
Well, now that artificial intelligence is available to these companies, they are using them to take a deeper look at claims to find fraud, waste, and abuse. They can spot outliers in an instant, and they can also identify abnormal billing patterns quicker than ever before. Since their contracts are dependent on their success, they’re incentivized to locate your missteps, too.
Use Your Clinical Records As Defense
To fight back against a UPIC audit, you need the evidence to support your claim. Not only do you have to prove that your office performed a procedure, but also that it was necessary. Your clinical records are how you can do that.
State Already Audited You?
Sometimes, a UPIC will target a practice that’s already been audited a state Medicaid agency. If that’s the case for you, it’s essential to inform the UPIC of funds that you’ve paid back or ways that you’ve addressed the issue. Otherwise, you could be asked to pay twice.
Handle A UPIC Audit With Dental Auditing Solutions
A UPIC audit is a legal situation, and dentists are not immune. If you’ve been targeted, talk to Dental Auditing Solutions at (972) 459-1508 today.