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Learn How to Avoid ZPIC Audits

Anything suspicious catches the ZPIC audits’ keen eyes. Anything that links the provider in any fraudulent activity will be shared with the prosecutor. Always comply with the rules and regulations to avoid any problems with your company. As a provider, you are a busy person. A call or a visit from a ZPIC representative would be the last thing that you would want to deal with.

            If the healthcare sector is the target of these contractors, how can you possibly avoid ZPIC audits to happen? Oberheiden & McMurrey gives clients advice across the United States and its territories with ZPIC Audits. The team is composed of former federal healthcare prosecutors who are experienced with ZPIC Audits and related issues.

Common Mistakes to Avoid.

             ZPIC Audits are used by the CMS to do an investigation with regards to fraud committed by beneficiaries, providers, other sources including CMS itself. When an audit is complete, auditors will refer the case of fraud to HHS OIG for consideration of any civil or criminal prosecution. It is important that providers are well-equipped to properly respond and cooperate with auditors. Avoid the common mistakes before and during a ZPIC Audit to also avoid any potential civil or criminal liabilities.

Tips for Providers.

  • Proper Documentation.

Always maintain proper documentation. This is the most important responsibility of a provider to successfully get through a ZPIC Audit. An auditor will suspect noncompliance, or worse, assume that the documents needed are nonexistent at all. Providers must know how to maintain documents to be prepared for ZPIC.

  • Self-Audit Regularly.

 Make it a point to always conduct self-audits on billing and coding operations. This is important since any mistake in coding and billing can be detected and detected beforehand. Through this effort, it reflects a provider’s real intent to remain as compliant as possible with Medicare rules and regulations. Providers should consult legal counsel who is well-experienced in conducting an effective internal audit.

  • Once an Audit Begins, Maintain a Detailed Chronology

Don’t let the auditor do all the work. You must also keep track of every step taken when an audit begins, meaning upon receiving a notice of a ZPIC Audit. This will keep the auditor accountable and also make sure that the provider is cooperative with all of the requests of the auditor. Proper documentation of all communications with the ZPIC auditor is important. Also, make a list of all the documents requested by the auditor.

  • Be Up to Date on Coding Changes and Regulations

Make sure your employees are educated about the ZPIC audit. This is by far the most effective way to avoid coding mistakes. Such mistakes are usually the result of carelessness and misinformation. Regularly educate your employees on coding updates to help avoid these problems.

  1. Provide coders with well-prepared, written instructions.
  2. Keep employees up to date with any changes in specific codes and regulations.
  3. The provider should not rely on the coders to maintain compliance.
  • During an Audit, Know the Scope of an Agency Relationship.

There is a great risk for mistakes in coding caused by another person’s carelessness or misinformation. If this happens, the provider should know how to use the contractor relationship to its benefit. In ZPIC Audit, the subcontractor relationship can help minimize the provider’s liability under these situations.

Dr. Nick Oberheiden and Lynette s. Byrd of Oberheiden and McMurrey, LLC have long track records of dealing with healthcare businesses and professionals, especially with healthcare fraud investigations. According to their ZPIC Audit Facebook posts, they have reached out and helped a number of people with regards to these cases. Don’t be a victim. Avoid ZPIC Audits as much as possible.


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