Friday, February 19, 2010
ZPIC Audit Update
According to the TAHCS general counsel,the first supplier
has been released from ZPIC audits which
included 100% prepayment audit.
This is a direct result of objections made by TAHCS general
counsel to the excessive number of audits preformed,
implementation of the 100% prepayment punishment status
and the excessive length of time required to complete the audits.
When contacted, the ZPIC counsel indicated it was not their
intent to "strangle" the providers, but rather to complete
their audits to rule out fraud and abuse.
Furthermore, the ZPIC has ceased telling providersthese
are random audits, after it was discoveredby general counsel,
all audits were pointed and fraud based.
More to follow as available.
Join TAHCS today!
Remember
UNITED WE STAND!TAHCS
TAHCS
Subscribe to:
Post Comments (Atom)
In dealing with the ZPIC we have had problems with communication feedback on our 100% prepay review. After a dozen requests we still cannot get any sort of written report on their findings regarding our review. Please reference the Medicare Program Integrity Manual Chapter 3.11.1.6, does anyone know anywhere else in the manual that states how the ZPIC is supposed to be communicating with us. We were told by a Medicare education rep that the ZPIC should be sending us a written quarterly report. Has anyone else heard of this?
ReplyDeleteRicky,
ReplyDeleteMy company is under a ZPIC review as well and we have not received any feedback. We submitted 23 charts and found out yesterday that they still have yet to look at them. Unfortunately, the PIM Chapter 3.11.1.6 has a section following in Chapter 3.11.1.8 which states for Fraud:
At any time, if the medical review detects possible fraud, refer the issue to the
appropriate Program safeguard contractor. See Pub. IOM 100-08, chapter 4, §2.1-
Examples of Medicare fraud.
The PCA requirements do not apply when a fraud development is initiated.
It looks like the rules don't apply to them. The only thing I've found that somewhat govern the ZPIC practices are in Chapter 4.2.2 but it seems like these ZPIC auditors have Carte Blanche.