If a ZPIC requests documentation from your practice, it’s vital that you comply with that request. A ZPIC audit can be a scary and intimidating process. It might be tempting to ignore a request for documentation and just hope it goes away. But remember that ZPICs have an important function. They help prevent Medicare fraud, which makes care more accessible for those who need it most.
Also, it’s important to keep in mind that a request for documentation doesn’t necessarily mean you will automatically face negative repercussions. Sometimes, once you provide the documentation that is requested, any questions are answered, and you won’t have any other issues to address.
However, ignoring the request for documentation can lead to far worse problems, that you wouldn’t have necessarily had to deal with if you had just provided the requested information.
What to Expect from a Documentation Request
If you get a ZPIC request for documents, it will most likely be a two-part request. The first part will ask for records related to your business, such as:
- Business contracts and agreements with other providers, physicians, suppliers, individuals, or businesses. Summarize verbal agreements in writing.
- A list of former and current employees who worked for you during a specific period, along with information about them including hire and termination date, reason for leaving, title, qualifications, last known address, and phone numbers.
- Any leases, medical director contracts, or employment agreements you have signed.
- A list of your practice locations, including addresses and phone numbers.
The second section of the request will list patient records and dates of service to be audited. A ZPIC might request documentation on eight to 300 claims, or more.
What Happens If You Fail to Respond?
If you fail to respond to the request for records or documents, your organization can be suspended from participation in the Medicare program. The ZPIC can also recommend a revocation action against your organization. In the face of a request for documentation, an attorney can protect your organization’s best interests, help you get more time if you need it, and help you prepare the correct documentation for the ZPIC’s review.
Failing to respond to a request for documentation can only make matters worse. Further, you could end up facing serious consequences that you might not have had to face, including complete suspension from the Medicare program.
Speak with an Experienced ZPIC Attorney Today
As you can probably guess, the best thing you can do is ensure that you have a qualified legal team on your side. If you have been contacted about providing documentation for a ZPIC, you should call us immediately for a consultation. You don’t want to risk making serious mistakes or accidentally failing to provide the information requested.
To learn more about a ZPIC audit and what you can expect if documents are requested, you can speak with one of our attorneys at Oberheiden & McMurrey, LLP. For a free and confidential consultation, call (888) 727-5159 or complete our online contact form today.