The most stressful parts of the ZPIC audits manifest when the federal government auditors discover a number of ways through which your Medicare claims don’t comply with the stipulated requirements.
You should always strive to avoid ZPIC assessments rather than allowing them to hamper your business operations. The hassle of filing a determination appeal can cost you time and money – and yet you won’t be sure if you will be taken out of the hook or not.
One of the ways of preventing ZPIC audits is training your staff on how to code documents and bill payments from Medicare.
In case your company is already a subject of ZPIC assessment, the first thing you should do is to contact a lawyer. A good and experienced lawyer will help you to handle the complex audit appeal procedures.
In the event that you are found liable and owe money to the federal government, an attorney can help in terms of minimizing the debt burden.
You don’t have to suffer in silence by paying large sums of money that can bring down your business. Consult an experienced law firm for advice on how to go about the whole situation.
Meeting regulatory requirements
Sometimes it is difficult to convince medical practitioners and administrators that proper documentation practices can help in avoiding ZPIC assessment – especially those that have never experienced a ZPIC assessment.
It is important to stress the value of filing and documentation to your staff and inform them how strict ZPIC auditors are when it comes to interpreting and implementing Medicare laws.
Your employees should be made to understand and comply with coverage and documentation requirements for the following:
• National Coverage Determinations
• Local Coverage Determinations
• The Medicare Policy Benefit Manual
• The Medicare Program Integrity Manual
• Local Medical Review Policies
Generally, if ZPIC auditors find that your company was overpaid, you will have to come up with a plan of paying back the extra money. Sometimes the extra payment can be huge and prove to be a challenge to manage.
Below are some of the option you have either to reduce or do away with the overpayment:
• If your company finding were in order
• If the ZPIC auditors offered the necessary information to prove their findings
• If the opinion of an expert was required and if it was sought or not
• Whether ZPIC auditors reviewed and utilized all the documents you provided them
• Whether a high or a sustained or high error rate was shown by the ZPIC auditors
What to do if you realize that the overpayment should be yours
You should note that an overpayment is always not proof of fraud neither does it imply that you may not have got an excess payment. Your business also has a right to get higher payments.
Most businesses often ignore – especially if the payment appears small compared to the hassle of getting it.
However, refusing to claim the payment from ZPIC can have a negative effect on your business. Every time you refuse to claim an what belongs to you, the error rate for your business goes up.
In the long run, the error rate will become so high and increase the chances of your company being audited again.
What should you do with Medicare overpayments?
Most companies are often caught up with the problem of Medicare overpayments – some intentionally while others unintentionally.
Sometimes you might try as much as possible to remain ZPIC compliant but still end up getting overpayments.
The way to deal with this situation is to send back what you know doesn’t belong to you.
Most business owners get tempted to keep quiet with the excess payment. All businesses have a maximum of 60 days to return the money from the day you discover the overpayment.
Seek help from an experienced federal ZPIC legal expert
It’s not easy to understand the ZPIC audit and all that it entails. Even if you try doing so, it will consume a lot of time and yet you won’t get everything right.
Considering what non-compliance can cost your business, it would be a good idea to hire the services of an expert.
There are many law firms that specialize in making companies and businesses ZPIC compliant. All you have to do if identify a reliable one and negotiate the rates for their services.