In the Zone

There are new kids in town and they aren’t very nice. Zone Program Integrity Contractors have made their presence known in Home Health in Louisiana. Our friends in TX and Florida have already met these folks. Now it is our turn.

So, what exactly is a ZPIC? The Zone Program Integrity Contractors are under contract with CMS to identify potential fraud and abuse using data from the National Health Claims database among other sources. Utilization patterns, error rates, diagnoses and high cost services are analyzed.

In Louisiana, the ZPIC contract has been awarded to AdvanceMed Corporation. AdvanceMed has also been awarded the contract for about half of the states. SafeGuard Services is the ZPIC contractor for Florida and Health Integrity is the contractor for Texas.

Why is it important that you know this? Because the letter that is sent to clients does not seem to be very important on the surface. Instead of saying, “Welcome to Hell,” on the fax cover sheet, it just goes on to address the administrator with some boring background stuff. You may get a faxed letter prior to receiving the certified one in the mail.

If you get one of these letters, don’t panic but don’t ignore it either. I assure you that neither of these options will produce the results that you want. The letter is the very beginning of a long, long process that will likely last for years. So, stay cool, warm up the copier and keep reading this week’s posts for further information. Meantime, stay on top of your incoming mail and faxes.

If you have any questions or want to share any ZPIC experience with readers, please feel free to leave a comment below. If you actually have a letter and feel like talking, call me. 225.253.4876.