Not all auditors are created equal

Thursday, August 26, 2010

YARMOUTH, Maine - Billing consultant Sylvia Toscano has a word for providers who get hit with a ZPIC audit: ZPICed.

"The ZPIC auditors are voracious," said Toscano, owner of Boca Raton, Fla.-based billing firm Professional Medical Administrators. "If a provider specializes in a particular item, they will get ZPICed for that item. I have seen up to 1,000 letters sent (to a provider) in a 30-day timeframe. It's a cash strangle and an administrative nightmare."

ZPIC audits have been taking place in zone 4 (Texas, Colorado, New Mexico and Oklahoma), zone 5 (10 states in the Southeast) and zone 7 (Florida, Puerto Rico and the Virgin Islands) for several months.

Not all auditors are created equal, said Toscano.

"Zone 7 is particularly difficult to work with," she said. "They won't speak to you, won't tell you the status--you are completely shut out from any information."

ZPIC isn't the only auditor vexing providers. OIG, CERT and RAC audits are continuing as well. All the auditors, however, seem to be operating with a little too much leeway, said John Shirvinsky.

"We are seeing some questionable interpretations and a general failure on the part of the auditors to either review data or to comprehend what the data means," said Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS).

Shirvinsky said it seems as though there is an unofficial policy to try and collect as many small claims as they can. He points to a recent OIG audit as an example.

"An auditor came down from Boston to one of our companies to audit a single claim for a CPAP mask," Shirvinsky said. "This happens to be a provider with an excellent compliance program and documentation. For this single mask, the auditor walked out with 75 pages of documentation and they asked for recoupment. The total claim was around $100." hme