Quante zone gestisce il Zone Program Integrity Contractor?

What does the Zone Program Integrity Contractors do?

Zone Program Integrity Contractors (“ZPICs”) are charged with the responsibility of investigating alleged instances of fraud, waste, or abuse by health care providers.

How many zones are in the Zone Program Integrity Contractor?

seven zones

As a result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which established seven zones throughout the United States for the purpose of processing Medicare claims, CMS created ZPICs to more effectively protect the Medicare program.

What is Medicare Drug Integrity Contractor?

National Benefit Integrity (NBI)-Medicare Prescription Drug Integrity Contractor (MEDIC), General Support System(GSS) is used to perform fraud and abuse investigation, support benefit integrity efforts, provide medical review support, national and regional data analysis, and law enforcement support.

What is a unified program integrity contractor?

“The Unified Program Integrity Contractors (UPICs) perform fraud, waste, and abuse detection, deterrence and prevention activities for Medicare and Medicaid claims processed in the United States.

What is not a responsibility of a Zone Program Integrity Contractor?

ZPICs do not handle complaints, audit cost reports, or process claims. All medical and documentation review is specifically for the purpose of verifying benefit integrity.

What triggers a UPIC audit?

UPIC audits are often generated through data analysis or by review of consumer complaints and most often target specific healthcare providers.

What does heat stand for in Medicare?

Health Care Fraud Prevention and Enforcement. Action Team (HEAT). With creation of new HEAT. team, fight against Medicare fraud became a.