zpic audits

UPIC / ZPIC / Health Integrity Opioid Audits and Audits of Other High Risk Drugs.

(June 23, 2017): Opioid audits of the prescribing practices of pain management physicians are on the rise. As the Department of Health and Human Services (HHS), Office of Inspector General (OIG), noted in its report “High Part D Spending o Opioids and Substantial Growth in Compounded Drugs Raise Concerns,” 30% of Medicare beneficiaries have at […]

UPIC / ZPIC / Health Integrity Opioid Audits and Audits of Other High Risk Drugs. Read More »

DME Audits are Back! Are Your Claims Compliant?

(December 22, 2015): The number of durable medical equipment (DME) audits conducted by Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) have surged in recent years. Medicare contractors have gradually increased their scrutiny of DME suppliers’ claims. This has resulted in increased postpayment audits of DME suppliers’ claims and associated overpayment demands made

DME Audits are Back! Are Your Claims Compliant? Read More »

Medicare Ophthalmology Audits: Is Your Practice Ready?

(October 26, 2015): Last month, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) released a study entitled “Questionable Billing for Medicare Ophthalmology Services.” As the study findings reflect, the OIG concluded that for the year 2012, approximately $171 million of the Medicare payments made that year for ophthalmology services were

Medicare Ophthalmology Audits: Is Your Practice Ready? Read More »

DME Claims Audits of Back Braces by OIG, MACs, and ZPICs are Likely to Further Intensify

(February 5, 2013): A “back orthosis” is type of brace that is placed on the outside of a patient’s body and is intended to help stabilize a patient’s spine. In some instances, it is used to limit motion. In others, it is used to address a structural deformity which may exist (such as scoliosis). There

DME Claims Audits of Back Braces by OIG, MACs, and ZPICs are Likely to Further Intensify Read More »

ZPIC Home Health Audits are Slated for the Future

(November 19, 2012): Zone Program Integrity Contractors, better known also as “ZPICs,” are continuing to focus on home health agencies (HHAs), hospice providers, and DME companies as the subject of their Medicare audits. Based on input from both the Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS), ZPIC audits

ZPIC Home Health Audits are Slated for the Future Read More »

A CMS ZPIC Contract is Quite Lucrative

(September 26, 2012): From the start, Zone Program Integrity Contractors (ZPICs) have worked to separate themselves from their proverbial “bounty hunter” peers – Recovery Audit Contractors (RACs). As you may know, ZPICs are paid on a contractual basis by the Centers for Medicare & Medicaid Services (CMS), instead of by how much money they return

A CMS ZPIC Contract is Quite Lucrative Read More »

HHS-OIG Finds ZPICs May Have Conflicts of Interest

(September 13, 2012): Many physicians and other health care providers around the country are reeling from post-payment and pre-payment assessments conducted by Zone Program Integrity Contractors (ZPICs). As ZPIC audits are being conducted, an issue has recently arisen regarding their independence. According to a recent report issued by the Office of Inspector General (OIG), the

HHS-OIG Finds ZPICs May Have Conflicts of Interest Read More »

Medicare Audits in Miami, FL

(August 28, 2012): In this feature, we focus on particular Medicare audits and appeals information for various ZPIC audit and RAC audit hotspots around the country. Check back in for information about Medicare audits and appeals in your city. Medicare Audits in Miami, FL: At-a-Glance Information: Miami Population: 408,750 (2011 Census)Medicare Administrative Contractor (MAC) (Parts

Medicare Audits in Miami, FL Read More »

Medicare Administrative Appeals Process – An Overview for New Providers

(August 15, 2012): Is this your first time being audited by a Medicare Administrative Contractor (MAC) or a Zone Program Integrity Contractor (ZPIC)? If so, the brief outline below can provide a handy summary of the Medicare appeals process. I. Step 1 – Request for Information: In most instances, a health care provider will receive

Medicare Administrative Appeals Process – An Overview for New Providers Read More »

Choosing the Right ZPIC Audit Appeals Attorney: Who is Best for You?

(July 19, 2012): Choosing the right ZPIC audit appeals attorney to represent your practice is possibly the most important step you can take to protecting your rights during the ZPIC audit and appeals process. Indeed, who your representative is in ZPIC cases can make all the difference in the world. It is not enough to

Choosing the Right ZPIC Audit Appeals Attorney: Who is Best for You? Read More »