Nursing Facilities and ZPIC Audits

Zone Program Integrity Contractors (ZPICs) are known to strictly scrutinize healthcare facilities especially the elder care and nursing homes sector. If you are an owner of a nursing home, or maybe an administrator or executive, your life is expected to be busy. The last thing you want in your day is to have outside auditors ask you questions.

 These contractors are paid to reveal any discrepancies from nursing home billing practices which they base under the Medicare billing regulations. The will do anything to find something wrong even if there is nothing to find. With ZPIC audits cause potential recoupment requests, Medical reimbursement denials or federal investigations, any nursing homes facing these audits would need to take action immediately.

 What is the Federal Government’s ZPIC Audit Program?

   The ZPIC audit program is the Medicare Modernization Act in 2003. This at is focused on the Centers for Medicare and Medicaid Services that aims to implement a “fee of service” program which is designed to reduce the Medicare billing issues throughout the healthcare industry. This is when they connected with Zone Program Integrity Contractors. The ZPIC are private companies that are being paid to target suspects of improper billing charges and Medicare fraud.

    ZPIC are responsible to enforce regulations for Medicare Parts A and B against nursing homes and other healthcare providers. Even though they are under CMS’s Center for Program Integrity, ZPICs have their own policies, procedures, and  understanding of the Medicare rules.

 Proper Response to a ZPIC Audit.

   ZPIC usually contacts anyone within the organization. Your staff should be aware that once this happens, there’s no time to relax. You need to act quickly to close communications and make sure that only the authorized individuals or properly trained staff disclose any information about your nursing home’s business with ZPIC. It is also best to seek legal representation before discussing anything.

    An experienced healthcare attorney is the best person to contact and educate your employees on how to deal with the ZPIC auditors if you are not around. This is to make sure that anyone from your staff does not disclose any information than what is absolutely necessary to help you and your employees avoid making any mistakes that can lead to dangerous outcomes.

  ZPIC Assigned Across the United States.

       Safeguard Services – Zone 1 – California, Hawaii, and Nevada 

       AdvanceMed – Zone 2 – Alaska, Arizona, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming 

       Cahaba – Zone 3 – Indiana, Illinois, Kentucky, Michigan, Minnesota, and Ohio 

       Health Integrity – Zone 4 – Colorado, New Mexico, Oklahoma, and Texas

       AdvanceMed – Zone 5 – Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia

       Safeguard Services – Zone 6 – Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, and Washington D.C. 

       Safeguard Services – Zone 7 –  Florida

It is important not to panic when you are contacted by any ZPIC representative. Know what to do and educate your employees as well. Never disclose any information until you have sought out legal advice. Protect yourself and your employees as well as the people in your nursing home.



Posted in Law