OASIS Alert

Published on Tue Nov 02, 2010 PDF

RACs and ZPICs have yet another set of eyes.

The Centers for Medicare & Medicaid Services is relying on another audit contractor -- and this one may have slipped your notice. Back in 2008, CMS quietly hired Provider Resources Inc. in Erie, Pa. to double-check Recovery Audit Contractors (RACs). The RAC Validation Contractor (RVC), through reports issued to CMS, "ensures that the RACs are not unnecessarily denying Medicare claims which were properly paid," it says on its website. "Similarly, our findings can also assure CMS that the RACs are properly recovering improperly-paid claims."  PRI also works with Zone Program Integrity Contractors on clinical review of medical records. "The results delivered by PRI staff are critical to the ZPIC process of identifying individual and systemic patterns of fraud, waste and abuse within the geographic boundaries of the ZPIC initiative," the contractor says.