Government Audit Alphabet Soup: RAC vs ZPIC and What These Audits Mean for Your Practices

Speaker: Joan Gilhooly, MBA, CPC, CPCO, President/Consultant, Medical Business Resources, LLC

Both of these government audit programs address the issue of improper payments, but how do they differ? In this session, we’ll address the key differences in each of these programs, the implications for billing services and their clients as well as how to stay on top of the process in the event one of these audits is initiated. We’ll address the implications for recoupment and Medicare’s appeal process in the event the provider disagrees with the government’s findings. And we’ll give you pointers on when to “go it alone” vs when to enlist outside help in this classic David vs Goliath confrontation that healthcare providers are facing all over the country.

Learning Objectives:

• At the end of this session, participants will be able to:
• Identify the difference between a RAC audit and a ZPIC audit request.
• Describe the difference between and automated RAC review and a complex RAC review
• State where the list of RAC audit topics for each jurisdiction can be found.
• List the recommended “next steps” when one of these audits occurs.

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