ZPIC Audit

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Question:

We’re hearing a lot about ZPICs and their focus on surgical practices. What is a ZPIC?

Answer:

ZPIC stands for Zone Program Integrity Contractors. ZPICs are private companies under contract to Medicare to identify areas of program fraud and abuse and to facilitate payment recoupment of misspent funds to Medicare. The focus of ZPIC auditors is the medical necessity of claims and coding errors. Medical necessity for Medicare payment is delineated in national or local carrier determinations, or NCDs and LCDs. ZPICs are very likely to audit procedures that have a current LCD, for example epidural and facet injections, kyphoplasty, etc. To avoid the adverse effect of a ZPIC audit, review the accuracy of your coding and your compliance with your carriers LCDs.