Navigating the ZPIC Appeals Process

zpic appeal

If your organization is the subject of a ZPIC audit, you could end up with millions of dollars in Medicare overpayments that you must pay back. But a ZPIC overpayment assessment isn’t necessarily the end of the story. You can appeal the assessment decision. However, over the past few years, the ZPIC administrative appeals process has become more and more complicated.  

The ZPIC audit by itself is complicated, and often overwhelming enough. After going through that arduous process, many business owners can’t even imagine tackling an appeal.

This is just one of the reasons you’ll need an experienced legal team on your side throughout the entire process. If not – at the very least – make sure you have someone to represent your business’s best interests when it’s time to appeal. Here are just a couple things you should know before attempting to navigate the ZPIC appeals process.

Bring Your Arguments Before an Administrative Law Judge

There are three levels of appeals that providers can file in order to challenge a ZPIC overpayment assessment. In our experience, it can be difficult to overturn a decision at the first two levels – the redetermination and reconsideration levels of appeal.

However, at the third level of appeal, you’ll have the chance to bring your case before an Administrative Law Judge (ALJ) who will be willing to hear you out regarding your arguments in support of payment.

Going into a hearing before an ALJ can feel very stressful, even though these men and women are typically fair-minded professionals who want to hear your reasons why the Medicare payments in question are valid. Of course, an attorney can speak for you at this hearing, which accomplishes two important things.  It takes a great deal of the burden off of your shoulders, and it ensures that your arguments are presented as professionally, efficiently, and persuasively as possible.

Hearings before an ALJ can also be complex. ZPIC representatives will be present, and also arguing their position before the judge. Other professionals, including statisticians, clinicians, and attorneys could speak on behalf of the ZPIC, especially if large amounts of money are at stake. An attorney will have the skills and knowledge needed not only to present your case in the best possible light, but to address concerns and arguments raised by the representatives of the ZPIC.

Speak with an Experienced ZPIC Appeals Attorney Today

You have a lot on the line, and you don’t want to risk it all attempting to navigate the ZPIC audit process alone. Even if you have already been audited and have received a decision, you might have other options, including the opportunity to appeal. Don’t risk making serious mistakes, or missing out on a chance to appeal the decision you’ve received from an audit.

To learn more about a ZPIC audit and what you can expect from the appeals process, you can speak with one of our attorneys at Oberheiden, P.C. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.