Home Health & Hospice Week

Zone Program Integrity Contractors use the blanket term of "aberrant billing" to describe how they target providers for review, notes attorney Edward Vishnevetsky with Thompson Coe Cousins & Irons in Dallas. But beyond that, it's hard to get specifics of how the ZPICs choose audit targets. (A representative from Zone 4 ZPIC Health Integrity deferred all questions for this story to the Centers for Medicare & Medicaid Services. CMS had not responded to inquiries by press time.)

It looks like outlier billing is one red flag. Therapy utilization is another, offers ZPIC consultant Tim Johnson with Jackson Davis HealthCare in Denver.

For hospices, eligibility for the benefit is a subject of scrutiny, Johnson adds. Don't be surprised if you haven't heard much about these ZPIC audits, Johnson says. Providers often keep them under their hats because it's embarrassing or reputationally harmful. "It's not good for business to get busted," Johnson points out.