Zone program integrity contractors (ZPICs) and the program safeguard contractors (PSCs) they are replacing have to notify providers of provider-specific or service-specific reviews.
An updated transmittal also notes that the notification must indicate whether the ZPIC or PSC is performing a pre-payment or post-payment review, according to
change request 8079/transmittal 485 issued Aug. 21.
The ZPIC or PSC will mail the notification on the same day that the edit request is forwarded to the provider’s Medicare administrative contractor (MAC), according to the change request.
The change request includes a template of the letter providers can expect to see that alerts them to the review.
Practices that read
Medical Practice Compliance Alert know all about ZPICs, PSCs, recovery auditors (RACs) and other contractors that review their claims, and they know the steps to take to mitigate the damage their audits can do.