zpic audits

OMHA Changes ALJ Hearing Case System

Medicare, Medicaid & Private Payor Updates /

(March 2, 2012): Likely recognizing the enormous disparity in Administrative Law Judge (ALJ) hearing workloads for its various Field Offices, the Office of Medicare Hearings and Appeals (OMHA) recently switched to a Central Docketing System for all pending and new appeals. Under this new system, all ALJ hearing requests will be sent to OMHA’s Central

OMHA Changes ALJ Hearing Case System Read More »

Data Mining Tools Can Help Identify Possible Problems

Regulatory Issues | Privacy | Other /

(February 8, 2012): While we all know that many Medicare post-payment audits are often generated as a result of sophisticated data mining analyses, the particular elements of concern which may give rise to a specific provider audit are not always so clear. Health care providers interested in compliance can use data mining assessment tools to

Data Mining Tools Can Help Identify Possible Problems Read More »

Data Mining is Being Used for ZPICs Targeting Purposes

Medicare, Medicaid & Private Payor Updates /

(November 16, 2011): Many providers believe that their practice is a normal one – average billings, average patient load, costs of care which are consistent with industry standards – and that they need not be concerned with undergoing a Medicare post payment audit for being a “statistical outlier.” As you may know, Medicare and Medicaid

Data Mining is Being Used for ZPICs Targeting Purposes Read More »

HHS-OIG Report Signals an Increase in SNF Audits by ZPICs

Medicare, Medicaid & Private Payor Updates /

(April 1, 2011): Skilled Nursing Facilities (SNFs) are again in the spotlight. A recent report likely signals an increase in future SNF Audits. The Prospective Payment System (PPS) under which SNFs are reimbursed by Medicare has long been criticized by many concerned with “benefit integrity” and curbing waste, fraud, and abuse in the Medicare program.

HHS-OIG Report Signals an Increase in SNF Audits by ZPICs Read More »

2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 11, 2011): ZPIC audits and ZPIC suspension actions are a serious risk facing non-hospital providers today. As you recall at the end of 2010 we identified the “Top Ten Health Care Compliance Risks for 2011”. The purpose of this article is to analyze two of those risks; Zone Program Integrity Contractor (ZPIC) audits and

2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions Read More »

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

Medicare, Medicaid & Private Payor Updates /

(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.

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