Defending Against Healthcare Audits: A Comprehensive Guide to UPICs, RACs, and ZPICs
Healthcare is one of the most regulated and complex industries that exist. The government contracts with various private companies called Unified Program Integrity Contractors (UPICs), Recovery Audit Contractors (RACs), and Zone Program Integrity Contractors (ZPICs) to conduct various functions including (not limited to): investigating potential fraud and abuse, performing medical reviews, performing data analysis, identifying outliers and areas that require further investigation, suspending program payments, coordinating efforts with other UPICs/RACs/ZPICs, making referrals to law enforcement, etc.
UPICs/RACs/ZPICs work on behalf of CMS to perform program integrity functions like detecting fraud, waste, and abuse (FWA) through sophisticated data mining and analysis. They operate as an extension of the government and have unique authority to suspend payments immediately. Regardless of the contractor involved in your situation, things have escalated, and you are on the radar! This session by industry expert Toni Elhoms, CCS, CPC, CPMA, CRC, CEMA, AHIMA-Approved ICD-10-CM/PCS Trainer will discuss the various pathways involved in a UPICs/RACs/ZPICs audit and investigation, primary objectives of the investigation, strategies for building a successful response, the importance of a qualified team, best practice tips, and so much more.
Webinar Objectives
Join industry expert Toni Elhoms for an in-depth session covering:
- The role and functions of UPICs/RACs/ZPICs audits
- Primary objectives of these audits and investigations
- Various pathways an investigation can take
- Strategies for building a successful response
- The importance of a qualified defense team
- Best practice tips and more!
Webinar Agenda
- Understanding Governing Authorities: Learn about the entities involved in investigating healthcare compliance.
- UPICs/RACs/ZPICs Audit Process: Detailed overview of the audit procedures.
- Current Audit Targets and Trends: Identify the latest focus areas and trends in healthcare compliance.
- Building a Successful Response: Strategies for assembling an effective defense team.
- Proactive Steps: Best practices to follow when undergoing an audit.
Webinar Highlights
- Identify the governing authorities responsible for healthcare compliance investigations
- Examine the different pathways involved in UPICs/RACs/ZPICs audits
- Explore the current targets of UPICs/RACs/ZPICs audits
- Analyze the latest trends in UPICs/RACs/ZPICs healthcare compliance audits
- Explain statistically valid sampling protocols
- Review protocols for the total universe of claims
- Discuss the error rate extrapolation methods used in UPICs/RACs/ZPICs audits
- Share proactive compliance best practices for UPICs/RACs/ZPICs audits
Who Should Attend
- Medical Coding Specialists
- Medical Billing Specialists
- Medical Auditing Specialists
- Private Practice Physicians
- Managed Care Professionals
- Operations Leadership
- Practice Administrators
- Office Managers
- Compliance Officers/Committees
- Chief Medical Officer
