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! In this webinar, our expert speaker 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.
Toni Elhoms is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Ms. Elhoms’ expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. Ms. Elhoms serves as ACE’s Senior Consultant and conducts training and educational seminars across the country on a variety of topics including, but…