Zapped by ZPIC? Avoid Suspension or Revocation Results

Event Information
Product Format
Prerecorded Event
Presenter(s)
Conference Date
Thu, Mar 23, 2017
Length
60 minutes
Product Description

ZPIC Audit Focus Areas and How Providers May Avoid Getting in Their Crosshairs


An audit notice from SafeGuard Services or another Zone Program Integrity Contractor (ZPIC) is far from routine and should set off alarm bells for providers. ZPIC audits typically focus on potentially abusive or fraudulent billing matters. For example, ZPICs may audit providers with a large number of claims arising after beneficiary dates of death. Providers typically have very short timeframes to justify audit exceptions and may find that the auditors misinterpret or do not take into account critical facts.

Further, negative findings can not only result in recoupment losses but in loss of billing status as well. Current laws give ZPICs authority to suspend payments if they suspect fraudulent conduct. Also, if a provider is found to have engaged in a pattern of inappropriate billing, Medicare can revoke status on that basis alone. Appeal options are limited and have to be acted upon quickly.

In this presentation, expert speaker Wayne J. Miller, Esq. will discuss the type of issues that ZPICs are focusing on today and how providers may avoid getting in their crosshairs. Wayne will also discuss what providers must do to improve their chances to succeed at the audit level, and the types of facts that could result in a suspension or revocation. Additionally, he will discuss best practices to improve success at the appeal level.

Session Highlights:

  • What are the top issues that may trigger a ZPIC audit?
  • Deadlines and best practices in responding to a recovery auditor inquiry
  • Under what circumstances will a ZPIC suspend a provider?
  • Types of scenarios that lead to revocation
  • How to wage a successful appeal
  • Considerations in self-disclosing negative events
  • Possible changes in audit rules under the new administration

Session Snapshots:

  • ZPIC and other Medicare audit sources
  • ZPIC: Goals, authority, powers and priorities
  • Unique characteristics of ZPICs
  • ZPIC audit aspects and responses
  • Applying overpayment rule to audit findings
  • Final 60 day rule
  • ZPIC focus areas
  • Possible defenses to adverse findings
  • CMS self disclosure (SRDP)
  • Self disclosure protocol availability
  • Waiver of liability
  • Noncompliance liability
  • Appellate rights

Who should attend?

  • Physicians
  • Medical groups
  • Medical group administrators or managers
  • Hospitals
  • Long term care facilities, and
  • Health care consultants

At the Q&A session following the live event, ask a question and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Wayne J. Miller - Healthcare Compliance Expert

Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...   More Info
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