CMS established the Zone Program Integrity Contractor (ZPIC) program to combat fraud, waste and abuse in the Medicare program. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, CMS established seven zones throughout the United States for the purpose of processing Medicare claims. ZPICs replaced Program Safeguard Contractors (PSC), which had been established by the Health Insurance Portability and Accountability Act of 1996.
The primary goal of ZPICs is to investigate instances of suspected fraud, waste, and abuse. ZPICs develop investigations, and take steps to ensure that Medicare Trust Fund monies are not inappropriately paid. They also identify any improper payments that are to be recouped by the MAC.
Why should you attend: Medicare Zone Program Integrity Contractors (ZPIC audits) can target physicians, home health agencies, hospices, skilled nursing facilities, DME suppliers and physical therapy billing among others.
ZPIC auditors are actively pursuing providers who are suspected of fraud. The ZPICs that align with the MACs all pursue providers with surprise on-site visits, targeted data analysis, random audits, 100% pre-payment holds, extrapolations and follow-up to whistleblower actions.
Mitigate the risks of ZPIC audits by being proactive. Don't miss this opportunity to learn what the government is doing to prevent improper Medicare payments. It could help you avoid costly claim denials and recoupments.
Areas Covered in the Session: