Medicare, Medicaid & Private Payor Updates

For AdvanceMed, it’s Not Personal, Just Business – Big Business

(March 26, 2010):  Over the next few days, we will be publishing a brief overview of specific Zone Program Integrity Contractors (ZPICs) (such as AdvanceMed) – the companies who have been hired by CMS to conduct the medical reviews of Part A and Part B health care providers around the country.  As we have previously …

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Will Another Bounty Hunter Be Conducting Medicare Audits?

(March 25, 2010): Yesterday, the White House announced that President Obama intends to back additional bipartisan plans to stamp out waste in government-run medical programs for the elderly and needy.  The White House said this new effort, which is being called nothing more than another bounty hunter program by its critics, is intended to root out …

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Is a ZPIC Tougher than a RAC or PSC When Conducting Medicare Audits?

(March 25, 2010): The Recovery Audit Contractor (RAC) program is an integral part of the Centers for Medicare & Medicaid Services’ (CMS’) “benefit integrity” efforts which seek to identify and recoup alleged overpayments paid to Medicare providers. Similarly, Program SafeGuard Contractors (PSCs) have been actively auditing Medicare providers and suppliers around the country. While the RAC program …

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Texas ZPIC Audits in Texas are Increasing – Is There a New Sheriff in Town?

(March 16, 2010): Health care providers around the country are finding themselves the target of various audits from jurisdictionally overlapping Medicare contractors.  Notably, any of these audits have the potential to destroy a provider’s practice or clinic.  States where PSCs (Program Safeguard Contractors) have transitioned to ZPICs (Zone Program Integrity Contractors) are under extreme pressure. …

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