Razor sharp focus on ZPICs, RACs

Tuesday, March 27, 2012

LAS VEGAS - Audits, audits everywhere and HME providers are looking for help. Not to worry, say presenters at Medtrade Spring 2012, because there are some serious seminars scheduled to address this increasingly problematic issue.

Under the spotlight in Las Vegas will be RAC (Recovery Audit Contractors) and ZPIC (Zone Program Integrity Contractors) audits, which financial specialists say have caused the most consternation among HME providers. 

"They struggle with both," said Mary Ellen Conway, president of Bethesda, M.D.-based Capital Healthcare Group and session co-leader for "Audit 9-1-1: A Hands-on Review of Sample Patient Records" on Tuesday, April 10, from 8 a.m. to noon. "Auditors ask for documentation that is hard to get and with ZPICs, providers often don't know their status for a long time."

To guide session attendees on how to handle these audits, Conway says she will hand out samples of patient records and let people audit them like an auditor would.

"They will review them and decide if the information is appropriate--if it is legible, has the right documentation or has no documentation," she said. "The value of this program is to provide hands-on review of records to show what auditors look for."

Wayne van Halem, president of the Atlanta-based van Halem Group, will co-present "Audit 9-1-1" with Conway, as well as direct a session called "Real World DatAnalysis and Mock Audit" on Tuesday from 3 p.m. to 4 p.m. 

"Over the last several months to one year, auditors have begun to do more 'complex' reviews, meaning they are requesting documentation from suppliers and having their clinicians review them for medical necessity," van Halem said. "Prior to that, they were only doing automated reviews, meaning they were placing edits in the system with no human interaction."

Looking at RAC websites, van Halem says contractors have their sights on HME, so they are becoming more prevalent, he said.

"I'm not sure how that will remain long term," he said. "A lot of Part B suppliers appeal the RAC decisions and many of them get overturned, so that takes a little incentive away from the RACs, because that money gets offset from future payments."

Kim Brummett, a member of the Medtrade Spring education committee, says that audits have taken on more importance at the show.

"These need to be in our sights as they will only increase and we need to be aware of what they are doing and how to respond," she said.