The Healthcare Provider's #1 Medicare Audit Defense & Medicare Appeals Resource
Medicare Audit Defense & Compliance Tools - ZPIC Appeals - RAC Appeals - CMS Program Integrity Resources

CMS is investing millions of dollars in dozens of separate – but coordinated – enforcement efforts to force providers to adhere to Medicare rules & regulations.  The target?  Everyone.  Hospitals, physicians, inpatient rehabilitation facilities, skilled nursing facilities, hospices, home health agencies, HME suppliers and physical therapists are all under fire.  In addition to now having thousands of contracted individual Medicare auditors under the CMS umbrella, the government is utilizing leading-edge database technology and integrated business logic to assist in the day-to-day review of millions of electronic Medicare claims for payment.  Providers can no longer fly under the radar of the Medicare audit process.  If you submit electronic claims for payment, you are instantly being “audited” for the services rendered.

How Can Jackson Davis Help?

For over 25 years, Jackson Davis HealthCare (JDH) professionals have been working with providers to identify, understand, document and synthesize Medicare Coverage Criteria.  We have reviewed 10,000s of Medicare cases and provide vital Medicare compliance guidance to providers and attorneys nationwide seeking to develop winning Medicare appeals.

As your unwavering advocate, JDH professionals are true Medicare compliance geeks.  We dedicate everyday to researching, analyzing and applying Medicare Coverage Criteria to cases being considered for Medicare audits and Medicare appeals - RAC appeals, ZPIC appeals, DOJ appeals, MAC appeals, MIC appeals or individual Medicare beneficiary appeals.

Medicare Appeals - Over the past 25 years, Jackson Davis professionals have assisted healthcare providers and Medicare attorneys nationwide in reviewing and appealing 10,000s of Medicare overpayment issues.  JDH partners with leading national and international law firms to maintain attorney-client privilege, establish codified work-product relationships and develop winning Medicare appeals.  We have established working relationships with the nation's best attorneys and they work hand-in-hand with JDH staff to bring you the best, most experienced and most cost-effective solution for your Medicare appeal needs.

Provider-Initiated Medicare Program Integrity Audits (PI Audits) - Jackson Davis HealthCare works closely with providers to complete proactive, detailed & comprehensive Medicare Program Integrity audits (or "PI Audits").  Each Medicare PI audit is centered on documented, codified CMS payment criteria and Medicare coverage criteria for selected focus areas and traditionally includes a pre-determined sampling of 20 - 1,000 patient encounters or admissions.  Each case is pre-screened and carefully selected based upon Medicare current or anticipated audit focus areas.  Let JDH physicians, nurses and Medicare compliance professionals go to work for you!

CMS Compliance Advisory Services - Providers nationwide retain JDH for retained monthly counsel or on a project-by-project basis.  Our staff is highly experienced and our knowledge and application of Medicare rules and regulations is unmatched in the industry.  We are Medicare coverage experts.  Whether it is a current Medicare audit challenge - RAC audit, ZPIC audit or MAC audit - or you are looking to be proactive and address any potential compliance issues, JDH is the nation's best resource.  From our physicians to our nurses to our compliance reseach team, we are in your corner and available 24/7 for your CMS compliance needs.

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Upcoming Medicare Audits & Medicare Appeals Webcasts - September / October / November 2011

September 6, 2011 - 2:00pm - 3:00pm EST
CMS Appeals for Healthcare Providers - Applicability of the Treating Physician Rule & Other Legal Arguments

This presentation will address CMS efforts to stop Medicare fraud, CMS audits, CMS appeals and the applicability of the "treating physician rule".  CMS and a wide range of judicial findings have determined the relative weight to be given to attending physician testimony, CMS payment criteria, independent medical evidence and other issues in pending appeal matters.  With Medicare RAC audits, Medicare PSC audits, Medicare ZPIC audits and Medicaid Integrity Contractor audits (MIC audits) rolling out nationwide and over 1 million RAC appeals being widely anticipated, it is critical that providers understand prior Medicare Appeals Council and U.S. court findings relating to these very important issues.

Please send your registration request and contact information to us via e-mail at support@cmsappeals.com.  Registrations must be received no later than September 5.  You will receive an e-mail confirmation with sign-on information and password prior to September 6.  The cost is $159 per healthcare provider or health law attorney.

October 4, 2011 - 2:00pm - 3:00pm EST
Managing the Risk of CMS Audits & CMS Appeals - Medicare & Medicaid (RAC Audits, PSC Audits, ZPIC Audits, MIC Audits & One PI)

This presentation will address the wide range of ongoing CMS efforts to stop Medicare fraud, CMS audits & law enforcement fraud initiatives.  Congress has allocated an unprecedented level of financial resources to insuring adherence to CMS payment criteria by providers nationwide - Medicare RAC audits, Medicare ZPIC audits, etc.  Jackson Davis works closely with hospitals, physicians, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies and physical medicine groups facing day-to-day challenges of both responding to audit requests and managing the risk of potential fraud allegations.  This is a critical education session for provider executive management and physicians. 

Please send your registration request and contact information to us via e-mail at support@cmsappeals.com.  Registrations must be received no later than October 3.  You will receive an e-mail confirmation with sign-on information and password prior to October 4.  The cost is $159 per healthcare provider or health law attorney.

November 8, 2011 - 2:00pm - 3:00pm EST
The CMS Appeals Process for Healthcare Providers - How the Game Has Changed

This presentation will address issues associated with Medicare audits / Medicare appeals - RAC appeals, ZPIC appeals, DOJ appeals, OIG appeals, MAC appeals, Medicare overpayment determinations and the Medicare appeals process.

As CMS continues to ramp up auditing efforts, providers nationwide are spending millions of dollars on legal fees, repaying tens of millions of dollars to CMS for conditional denials and being exposed to potential Medicare fraud allegations.  This discussion will provide an in-depth look at the Medicare appeals process and explore a wide range of opportunities for providers to proactively build winning Medicare appeals (RAC appeals, ZPIC appeals, etc.).  The old days of soft regulations and provider education are over - it is absolutely vital that providers understand how the game has changed.

Please send your registration request and contact information to us via e-mail at support@cmsappeals.com.  Registrations must be received no later than June 27.  You will receive an e-mail confirmation with sign-on information and password prior to June 28.  The cost is $159 per healthcare provider or health law attorney.