Navigating UPICs/RACs/ZPICs Audits

Toni Elhoms

Toni Elhoms

Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer is a nationally known speaker and recognized subject matter expert on medical coding, reimbursement, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC. She holds multiple credentials with the American Health Information Management Association...
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July 11, 2024
01:00 PM ET | 12:00 PM CT
60 Mins

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

This webinar will cover the role and functions of UPICs/RACs/ZPICs audits, highlight the objectives of a UPICs/RACs/ZPICs audit and investigation, the various pathways the investigation can take, how to assemble a competent and qualified defense team, discuss best practices, and so much more!

Webinar Agenda

  • Understand the governing authorities involved in investigating healthcare compliance
  • Recall the UPICs/RACs/ZPICs audit process
  • Recognize current UPICs/RACs/ZPICs trends audit targets in healthcare compliance
  • Recall strategies for building a successful response during a UPICs/RACs/ZPICs audits
  • Understand the appropriate steps to take when undergoing a UPICs/RACs/ZPICs audits

Webinar Highlights

  • Outline the governing authorities involved in investigating healthcare compliance
  • Review the various pathways involved in UPICs/RACs/ZPICs audits
  • Discuss the current UPICs/RACs/ZPICs audit targets
  • Deconstruct current UPICs/RACs/ZPICs audit trends in healthcare compliance
  • Discuss statistically valid sampling protocols
  • Review total universe of claims protocols
  • Discuss the process of error rate extrapolation employed by UPICs/RACs/ZPICs in audits
  • Discuss proactive compliance best practice tips 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
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