Overview of the Zone Program Integrity Contractor (ZPIC) Program
- Zone 1 – CA, NV, American Samoa, Guam, HI and the Mariana Islands.
- Zone 2 – AK, WA, OR, MT, ID, WY, UT, AZ, ND, SD, NE, KS, IA, MO.
- Zone 3 – MN, WI, IL, IN, MI, OH and KY.
- Zone 4 – CO, NM, OK, TX.
- Zone 5 – AL, AR, GA, LA, MS, NC, SC, TN, VA and WV.
- Zone 6 – PA, NY, MD, DC, DE and ME, MA, NJ, CT, RI, NH and VT.
- Zone 7 – FL, PR and VI.
- Take care before conducting an internal review of the claims requested. While an internal analysis can be invaluable, you want to avoid creating a non-privileged paper trail of identified problems. Remember, both ZPICs and RACs may make a referral to law enforcement if their assessment indicates that problems may be more than a mere overpayment.
- Review past claims audits and evaluations to determine whether these claims have been previously evaluated.
- Note the claims denied and calculate when appeals must be filed. Review the reasons given for each denial.
- Has the contractor correctly cited Medicare policy? Do not automatically assume the contractor’s arguments are meritorious.
- Appeals must be filed in a timely fashion. Moreover, all supporting documentation and arguments must be submitted to the QIC
Should you have any questions regarding these issues, don’t hesitate to contact us. For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.