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Understanding the Ins and Outs of a ZPIC Compliance Plan

ZPIC denial decision audit

If you’re a small-to-mid-sized provider practice and you don’t have a ZPIC compliance plan in place – you’re not alone. Many smaller providers become so overwhelmed with the day-to-day realities of caring for patients that they let building and implementing a compliance plan fall by the wayside. But drafting and implementing such a plan can help you be prepared for a ZPIC audit before such an audit ever takes place.

However, trying to determine where you should start can be complicated. To get you started, here are a few things you should know about creating and maintaining a ZPIC compliance plan for your business.

Make Sure You Avoid Fraudulent Activity

Although it might seem like an obvious element, it’s important that you, your organization, and your employees avoid any fraudulent activity. However, sometimes people can engage in activities considered fraudulent without even knowing it. This is just one of the reasons it’s important to have a plan in place, to protect your business and its employees. A ZPIC compliance plan is a strategy you can implement to stay on the right side of Medicare billing regulations, so that you can rest assured that no one in your practice is committing Medicare fraud, inadvertently or otherwise.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Attorney-at-Law & Founder

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Lynette S. Byrd
Lynette S. Byrd

Former Federal Prosecutor

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Subodh Chandra
Subodh Chandra

Former Federal Prosecutor

R. Brandon Johnson
R. Brandon Johnson

Former Federal Prosecutor

Roger Bach
Roger Bach
(Non-Lawyer)

Former Special Agent, OIG

Dennis A. Wichern
Dennis A. Wichern
(Non-Lawyer)

Former Special Agent-in-Charge

Chris Anderson
Chris Anderson
(Non-Lawyer)

Compliance Consultant

Beverly Gibson
Beverly Gibson
(Non-Lawyer)

Compliance Auditor & Consultant

Joe Lewis
Joe Lewis
(Non-Lawyer)

Pharmacy Compliance

Valerie Rivera
Valerie Rivera
(Non-Lawyer)

Private Investigator

You need to put a ZPIC compliance plan tailored to the unique needs of your practice into place immediately. Section 6401 of the Affordable Care Act (ACA) requires all medical providers who wish to participate in the Medicare program to establish such a plan. If you have difficulty with any part of this process, you should consult a qualified attorney for assistance.

Compare Your Practices with Regulatory Provisions

First, review the statutory and regulatory provisions related to any services your practice bills to Medicare. Then, compare your actual documentation, coding, and billing practices with Medicare guidelines. Immediately take steps to fill any gaps between your practice’s billing, coding, and documentation practices and the Medicare rules regarding these practices. If you find an overpayment, you need to repay this money to the government within 60 days.

Before you perform an analysis of your billing, coding, and documentation practices, it’s a good idea to enlist the help of an attorney who can ensure that your internal review is accurate and your compliance plan effective.

Let a Trusted and Experienced Federal Attorney Help with Your ZPIC Compliance

Does your organization or facility have a ZPIC compliance plan? Chances are, you aren’t as prepared for a ZPIC audit as you might think. In order to protect your business, employees, and clients, you’ll need to ensure you have a qualified ZPIC legal team on your side from the beginning to the end.

Make sure you don’t make costly mistakes that can affect your business and its employees. To learn more about defending yourself against a ZPIC audit or if you need assistance filing a ZPIC appeal, you can contact the attorneys at Oberheiden, P.C.. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.

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