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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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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