ABCs of ZPICs (Zone Provider Integrity Contractors)
Overview:
CMS established the Zone Program Integrity Contractor (ZPIC) program to combat fraud, waste and abuse in the Medicare program. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, CMS established seven zones throughout the United States for the purpose of processing Medicare claims. ZPICs replaced Program Safeguard Contractors (PSC), which had been established by the Health Insurance Portability and Accountability Act of 1996.
The primary goal of ZPICs is to investigate instances of suspected fraud, waste, and abuse. ZPICs develop investigations, and take steps to ensure that Medicare Trust Fund monies are not inappropriately paid. They also identify any improper payments that are to be recouped by the MAC.
Why should you attend: Medicare Zone Program Integrity Contractors (ZPIC audits) can target physicians, home health agencies, hospices, skilled nursing facilities, DME suppliers and physical therapy billing among others.
ZPIC auditors are actively pursuing providers who are suspected of fraud. The ZPICs that align with the MACs all pursue providers with surprise on-site visits, targeted data analysis, random audits, 100% pre-payment holds, extrapolations and follow-up to whistleblower actions.
Mitigate the risks of ZPIC audits by being proactive. Don't miss this opportunity to learn what the government is doing to prevent improper Medicare payments. It could help you avoid costly claim denials and recoupments.
Areas Covered in the Session:
- Medicare Program Integrity
- ZPIC Overview and Objectives
- ZPIC Audit Process
- Appeal of Unfavourable Audit Results
- Tips for Preparing for ZPIC Audits
- Administrators
- Chief Executive Officers
- Chief Financial Officers
- Compliance Officers
- Individuals who work in the Healthcare Industry
Speaker Profile
She establishes compliance department operations to include planning, designing, and implementing system-wide Corporate Compliance and HIPAA/HITECH Programs. She writes Codes of Ethical Conduct and compliance policies and procedures for providers.
In a previous position, Dr. Freville assisted with the design and management of a company-wide infrastructure to support a Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services with clinical and financial components.
In addition, she was a Senior Medicare Auditor and has over 14 years experience as Directors of Finance, Accounting, and Reimbursement in home health, hospital, pharmacy, and long-term care. In addition, she was a healthcare Compliance Officer for 13 years. Dr. Freville retired from the U.S. Army Reserve as a Command Sergeant Major.
Dr. Freville earned a doctorate in Human Services with a specialization in Health Care Administration from Capella University. In addition, she earned a Master of Business Administration from Webster University, a Bachelor of Science in Accounting from Arizona State University, and is certified in Health Care Compliance (CHC) and Health Privacy Compliance (CHPC). Additionally, she is a member of the Health Care Compliance Association, Louisville Armed Forces Committee and Federal Bureau of Investigation Citizen Academy Alumni.