In July 2013, CMS released a Request for Information and conducted an Industry Day targeted at gathering information from the vendor community on possible requirements for combining Medicare and Medicaid program integrity functions.Īs a result, UPICs will perform many of the functions currently contracted to ZPICs and MICs. This contractor will conduct Medicare, Medicaid, and Medi-Medi investigations and audits within designated geographic jurisdictions. Under this strategy, Medicare and Medicaid program integrity audit and investigation work at the federal level will be consolidated into a single contractor within a defined multi-state area, which will complement audit and investigation efforts by states. To improve efficiency and coordination of federal data analysis and audit/investigation work within each region, CMS is developing a Unified Program Integrity Contractor (UPIC) strategy. All comments are posted and available to the public, edited here only for clarity (apparently, grammar is not a ZPIC job requirement). Nevertheless, the way ZPIC employees talk about their employer and working environment reveals quite a lot about the skills and mental preparedness they bring to the task of examining your claims.įor your enlightenment, we compiled the following representative sample of comments from current and former employees of some of CMS's Zone Program Integrity Contractors. Unhappy customers and employees tend to complain and happy customers and employees tend to keep quiet. So we turned to the place where employees themselves could answer that question, online review sites. We wondered what it might be about the ZPIC working environment - training, salary, vacations, and management-employee relations - that would lead to such frequent errors. Upon appeal, the payment is restored because the ZPIC employee misunderstood a pertinent rule, or mistakenly applied a hospital or physician rule to a home health claim, or completely made up a rule that never existed. Investigators and auditors working for Medicare's four Zone Program Integrity Contractors cite an error of care - or documentation of care - and demand repayment from a healthcare provider. This seems to be happening more and more often lately.
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