Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 08, 2010 PDF

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The lines may get blurry when it comes to ZPIC (Zone Program Integrity Contractors) requests for documentation, but don't expect help from your intermediary on the matter. "Although Palmetto GBA adjudicates claims once the review is complete, Palmetto GBA does not conduct the medical reviews requested by the ZPIC," the intermediary explains in a Zone Program Integrity Contractor update on its Web site.

"Since these reviews are being done by an entity other then Palmetto GBA, questions and correspondence related to the review and results of the review need to be directed to the source of the request."

Palmetto does adjudicate the claim -- recoup funds -- once the ZPIC makes a claim determination, Palmetto says, and the carrier hears the appeals for ZPIC-denied claims. "The process for filing a redetermination based on a ZPIC decision is unchanged," the intermediary says. But providers "should include a copy of the overpayment letter from Palmetto GBA and the spreadsheet from the ZPIC or the Program Safeguard Contractor (PSC) when requesting the redetermination," Palmetto adds.