You’ve Received a ZPIC Denial Decision Letter – Now What?

denial decision letter

Few things are more stressful than a ZPIC audit, but finally receiving the denial decision letter is one of them. The receipt of a denial decision letter could mean that your organization is on the hook for potentially millions in Medicare overpayments. But don’t panic just yet.

Read the Letter Carefully

The first thing you should do when you receive a ZPIC denial decision letter is read the letter carefully. The ZPIC may specifically name the reasons for its denial decision. However, the audit process varies from one ZPIC to the next, and the letter may provide only general reasons for the denial decision. If the ZPIC doesn’t provide sufficient information about the decision in the letter, you may need to consult your attorney in order to discover why your claims have been denied.

It might be difficult interpreting the decision from your letter, so if you have any questions or concerns at all, it’s in your best interests to let a ZPIC attorney take a look at it.

Enlist the Help of an Attorney

Once you have determined the reasons why your claims have been denied – or if you cannot ascertain these reasons from reading the letter – it’s time to contact your attorney. The denial of claims may result in the recuperation of pending payments by your Medicare Administrative Contractor (MAC). You have 120 days to file a redetermination appeal. However, if you want to keep your MAC from confiscating your pending Medicare payments, you will need to file your redetermination appeal within 30 days of receiving the demand letter from your MAC.

Your attorney can help you establish a payment plan so that you can take full advantage of the 120-day appeal period, without risking the confiscation of pending payments by your MAC. It is important that you consult an attorney as soon as possible to ensure you have the best chance at appealing the decision.

Even if you haven’t had a lawyer assist you throughout the audit process, you’ll need one to help determine the best way to move forward. This could mean an appeal or other process that will be difficult to navigate by yourself.

Contact an Experienced ZPIC Audit Attorney Today

As you can probably guess, the best thing you can do is to have a qualified legal team on your side throughout the ZPIC audit. Once you have received your decision letter, you’re legal team will help determine your options. Let us plan your appeal and assist you and your business through the ZPIC audit process. You may have more options than you think.

To learn more about a ZPIC audit and what you can expect once you have received your decision letter, you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.