tci Medicare Compliance & Reimbursement - 2013 Issue 1

Compliance: Win A ZPIC Appeal With These Expert Pointers

Make documentation back up your claims. Present your arguments cogently to your Zone Program Integrity Contractor (ZPIC) auditor and back it up with documentation rather than getting daunted by the appeals process. If you’re unfortunate enough to have an unfavorable audit, you should know that ZPIC appeals work in the same way as other CMS appeals processes -- except for the potential inclusion of Medicare fraud issues. Here are some tips for winning a ZPIC appeal, courtesy of Medicare audit defense and appeals firm Jackson Davis HealthCare: Submit all documentation. You must file all the required supporting documentation...

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