Medicare Unified Program Integrity Contractor

Although other Medicare audits continue to plague providers, Medicare UPIC contractors focus their efforts to deny claims throughout the country!

The unfortunate fact is that you will be targeted sooner than later, if you have not already been notified of this type of Medical Review.

WE ARE HERE TO HELP!

We use our extensive knowledge to properly format and index clinical documentation at the ADR (Additional Documentation Request) level. This includes providing recommendations to address allowable alterations, identifying missing information that would normally be included within a Home Health episode of care and providing expert opinion based on Medicare Eligibility and Coverage guidelines.

We manage redetermination and mid-level appeals for Medicare, Medicaid and other payer types. Utilizing Program Integrity and Benefit Policies, along with our years of experience, we are able to consistently rebut and provide evidence to support claim payment. By providing accurate rebuttals we are able to further increase the success rate moving towards ALJ Hearing.

We represent our clients with great success at the ALJ (Administrative Law Judge) level. Our consultants have prepared filings and represented providers under the following programs; Zone Program Integrity (ZPIC), Benefit Integrity and Recovery Audit Contract (RAC), Unified Program Integrity Contractor (UPIC), Targeted Probe and Educate (TPE), Third Party Liability (TPL) and more.

Appeals Specialist Spotlight

Joe Osentoski, BAS, RN-BC

Joe specializes in additional documentation request (ADR) responses and appeals. As a registered nurse for more than twenty-five years, his career has included clinical consulting in home health and hospice specializing in clinical quality assurance and regulatory compliance.

He also has extensive experience with all types of Medicare audits and probes from the variety of Medicare contractors. Joe has completed over 5,000 ADRs in home care and hospice, filed thousands of appeals and has attended hundreds of Administrative Law Judge (ALJ) hearings on behalf of clients.

Impressively, Joe has been lauded by retired US Administrative Law Judge (ALJ) Robert Soltis in his book, How to Handle Your Medicare Hearing: “Mr. Osentoski was one of the first non-attorney representatives to appear before me when I was an ALJ, and he stands head and shoulders above every other non-attorney representative. Mr. Osentoski…knows home health law, and prepares thoroughly. His credibility is beyond reproach.” He is a contributor to industry newsletters Home Health Line and Eli’s Home Care Week. Joe is also author of the book The ADRs and Appeals Handbook, First Edition, from Decision Health.

www.gatewayhhc.com I (248) 230-9588 I info@gatewayhhc.com