Under the Microscope: Real-World Medicare Audits,Lessons Learned & What We’d Do Differently Lunch & Learn

Lunch & Learn

Revenue Cycle
Lunch & Learn

Under the Microscope: Real-World Medicare Audits,Lessons Learned & What We’d Do Differently Lunch & Learn

Medicare audits are rarely straightforward—and the most valuable insights often come from experiencing them firsthand. In this session, presenters will walk attendees through two real-world Medicare Unified Program Integrity Contractor (UPIC) audits from start to finish, offering an unfiltered look at the audit process, documentation requests, timelines, communications, and outcomes. Through these case studies, participants will hear what went well, where challenges arose, and how decisions made along the way impacted the final results. The session will also explore lessons learned from audits that did not conclude favorably, highlighting how unfavorable outcomes can still drive meaningful operational improvements, compliance enhancements, and future audit readiness. Lunch will be served from 11:45 PM – 12:15 PM Session will start at 12:15 PM, offering 1.25 CE

Medicare audits are rarely straightforward—and the most valuable insights often come from experiencing them firsthand. In this session, presenters will walk attendees through two real-world Medicare Unified Program Integrity Contractor (UPIC) audits from start to finish, offering an unfiltered look at the audit process, documentation requests, timelines, communications, and outcomes. Through these case studies, participants will hear what went well, where challenges arose, and how decisions made along the way impacted the final results. The session will also explore lessons learned from audits that did not conclude favorably, highlighting how unfavorable outcomes can still drive meaningful operational improvements, compliance enhancements, and future audit readiness. Lunch will be served from 11:45 PM - 12:15 PM Session will start at 12:15 PM, offering 1.25 CE

Learning Objectives

Explain the functions, responsibilities, and operational scope of the Medicare Unified Program Integrity Contractor (UPIC).

Identify the preparatory steps providers should take prior to a UPIC audit and outline the appropriate actions to follow throughout the audit process.

Apply best‑practice strategies for effectively navigating the Medicare administrative appeals process, from initial determination through all levels of review.

Assess the potential consequences associated with UPIC investigations and describe the investigative tools and authorities available to UPIC contractors.

Speaker(s)

Noel Neil JM, CDME Chief Compliance Officer
ACU-Serve LLC

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Noel Neil JM, CDME
Chief Compliance Officer
ACU-Serve LLC

Lunch & Learn