Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 13, 2010 PDF

Keep your eye on ZPICs, as their audits may be more liable to close your doors than any other Medicare contractor's.

That's because the Zone Program Integrity Contractors are authorized to use statistical sampling to identify overpayments from providers. That means millions of dollars in overpayment demands can come from a relatively small sample of claims. "Zone Program Integrity Contractors (formerly Program Safeguard Contractors) are organizations hired indirectly (or in connection with other CMS affiliated contractors) by CMS to perform a wide range of medical review, data analysis and Medicare evidence-based policy auditing activities," notes ZPIC consulting firm Jackson Davis HealthCare on its Web site. "While ZPIC audits are similar in many ways to other CMS audits currently being performed nationwide they do differ in one very important aspect " potential Medicare fraud implications. Of all the current CMS audit initiatives -- RAC audits, MIC audits, etc. " it is vital that providers facing PSC audits or ZPIC audits immediately and effectively address targeted audit issues."

The ZPIC auditors have recently been focusing their efforts on "physician, physical therapy, skilled nursing facility and DME supplier billing," the Web site indicates.

For more on ZPIC audits, visit http://stopmedicarefraud.com/Medicare_ZPIC_Audits.html.

Claims after that will be subject to the new stricter one-year filing deadline, Cahaba notes. That counts from the "through" date on the claim.

For example: "A claim submitted with a 'From' date of 10/01/10, and a 'Through' date of 10/31/10, must be received by 10/31/11," it says.