Medicare and Medicaid Audit Defense & Appeals: From RACs to ZPICs (Presentation)


In This Presentation:

Acronyms; MEDICARE V. MEDICAID AUDITS; RECOVERY AUDIT CONTRACTOR PROGRAM; Background of the RAC Program; Demonstration Program; Permanent Program; Who are the Medicare Recovery Audit Contractors?; Illinois’ Medicare RAC; Getting Prepared; RAC Claims Review; What are RACs looking at currently?; THE FOCUS OF CURRENT RAC AUDITS; The Audit Process; After the Audit; RAC Process; Keys for a Successful RAC Appeal; Steps That Home Health Agencies Should Consider Prior to Receiving a RAC Audit Letter; New Recovery Audit Prepayment Review Demonstration; RAC Prepayment Review Program; Medicaid RAC Program; Illinois’ Medicaid RAC; Medicare RACs v. Medicaid RACs; Medicaid RACs; Medicaid Integrity Program v. Medicaid RACs; ZONE PROGRAM INTEGRITY CONTRACTORS; ZPIC vs. RAC: What’s the Difference?; How do ZPICs find cases of fraud, waste and abuse?; ZPIC Background; ZPIC Zones; Illinois ZPIC; Overview of ZPIC Functions; Potential Fraud; Medicare Fraud Examples; Investigation; Investigation: Record Review; Not ZPIC Functions; ZPIC Actions; Referral Actions; Appeals; MEDICAID INTEGRITY CONTRACTORS (MICS); MIC Target Areas; MIC Specifics; Medicare Administrative Contractors (MACs); Important Aspects of Home Health Medicare Compliance: Face-to-Face Requirements; Additional Key Audit Risk Issues for Home Health; and, Effective Home Health Compliance Measures.

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