Provider Relations, Audits, Appeals and Negotiations Unit (PRAAN)

BMD provides a full range of proactive and defensive strategies with respect to reimbursement audits and appeals for all types of providers, including hospitals and health systems, skilled nursing facilities, home health agencies, DME providers, and single and multi-specialty group practices. BMD has a broad range of experience with various types of auditors.

Areas of service include:

• Medicare and Medicaid Recovery Audit Contractors (RACs)
• Medicare Administrative Contractors (MACs) and CERT Reviews
• Zone Program Integrity Contractors (ZPICs)
• Office of Inspector General (OIG)
• State Medicaid programs
• Prepayment reviews
• Commercial carrier audits and payment disputes

BMD also assists providers with internal audits and investigations as well as self-disclosure protocols with respect to billing and overpayment issues. BMD counsels providers on developing proactive strategies to prepare for an external audit or investigation, prevent overpayment determinations, and mitigate audit activity. Finally, BMD also advises clients as to proactive billing policies such as prompt pay discounts and out-of-network strategies.

Representative Matters

• BMD's Provider Relations, Audits, Appeals and Negotiations Unit (PRAAN) received a favorable Medicare Redetermination Decision (Level 1) overturning a $3.6 million overpayment allegation following a UPIC audit.