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Home Health & Hospice Week

Industry Notes:

Intermediaries Won't Field ZPIC Questions

Published on Tue Oct 26, 2010

They will take your ZPIC appeals, though. The lines may get blurry when it comes to ZPIC requests for documentation, but don't expect help from your intermediary on the matter. "Although Palmetto GBA adjudicates claims once the review is complete, Palmetto GBA does not conduct the medical reviews requested by the ZPIC," the intermediary explains in a Zone Program Integrity Contractor update on its website. "Since these reviews are being done by an entity other then Palmetto GBA, questions and correspondence related to the review and results of the review need to be directed to the source of the request." Palmetto does adjudicate the claim -- recoup funds  once the ZPIC makes a claim determination, the RHHI says. And Palmetto hears the appeals for ZPICdenied claims. "The process for filing a redetermination based on a ZPIC decision is unchanged," the intermediary says. But home care providers "should include a copy [...]
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