Medicare Compliance & Reimbursement

New Medicare program will zero in on aberrant billing trends in your claims.

Just when you thought CMS couldn't crack down on medical practices any more than it already does comes news that the agency's scare tactics have reached an all time high -- and your practice better take notice.

CMS announced on Oct. 6 that it will soon implement its newest plan -- appointing program integrity contractors who will review billing trends and patterns among Medicare claims. "They will focus on companies and individuals whose billings for Medicare services are higher than the majority of providers and suppliers in the community," the CMS announcement noted.

Reality: "What CMS is trying to tell practices is that an audit could be coming to the office next door," warns Barbara Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, senior coder and auditor for The Coding Network, and previous member of the AAPC National Advisory Board. "Medicare is looking at patterns and they're using the information they find in those patterns to target practices for audits," she says.   

CMS appointed "Zone Program Integrity Contractors (ZPICs)" to ensure the integrity of all claims under Medicare Parts A, B, C, and D. "The interesting thing about the ZPICs is that, like the recovery audit contractors (RACs), the ZPICs will collect a percentage of the money they recover," Cobuzzi explains.

CMS has faith in the new program, which it expects will help the agency recover significant misspent Medicare dollars. "By enhancing our oversight efforts we can better ensure that Medicare dollars are being used to pay for equipment or services that beneficiaries actually received while protecting them and the Medicare trust fund from unscrupulous providers and suppliers," said CMS Acting Administrator Kerry Weems in the Oct. 6 statement.