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ED Coding and Reimbursement Alert

Compliance Update:

Bone Up on Your Regional ZPIC's Functions And Stay Out of Trouble

Published on Wed Mar 21, 2012

Do you understand how this extra layer of investigation fits in the overall program integrity picture?CMS is clearly delineating for ED providers and their billing agents the statutory mandate, mission, purpose and goals of the Zone Program Integrity Contractors (ZPICs) -- and if you're not up to speed, you're heading for audit troubles. The ZPICs replaced the entities known as the "Program Safeguard Contractors", says Ed Gaines, JD, CCP Chief Compliance Officer for Medical Management Professionals, Inc, in Greensboro, NC.The main focus of a ZPIC is detecting, preventing and referring potential cases of Medicare fraud, waste and/or abuse. "Fraud" may include but not be limited to the traditional notions of an express intent to deprive the Medicare program of funds. Under the federal False Claims Act (FCA), "fraud" may include situations where the provider or billing agent was "deliberately ignorant" or "reckless" about the truth or falsity of the claim [...]
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