Coding Corner Question

In this month’s coding article, the topic is the Zone Program Integrity Contractor (ZPIC) audits (see Practice Page, for more on these audits). The following questions will help test your knowledge on appeals and denials.

1. What can be a consequence for failure to comply for a request of medical records?
   1. Nothing. You have a right to deny access to medical records.
   2. The provider’s National Provider Identifier (NPI) number will be suspended immediately.
   3. The provider will have to close his practice until he complies with the request.
   4. None of the above.
2. When a provider is audited, whether by a Recovery Audit Contractor or ZPIC, there are five levels to the appeal process. What are they?
   1. _______________________
   2. _______________________
   3. _______________________
   4. _______________________
   5. _______________________
3. How can a provider stop the automatic recoupment of an overpayment?
   1. Call the carrier to let them know the practice is appealing the audits.
   2. There is nothing a provider can do; it is an automatic recoupment.
   3. Someone from the practice will have to submit a request in writing within 30 days stating there will be an appeal of the audit.
   4. None of the above.
4. A ZPIC audit targets fraud and abuse.
   1. True
   2. False
5. What items should be used when appealing an audit?
   1. Local coverage determinations.
   2. National coverage determinations.
   3. Peer reviewed clinical data.
   4. All of the above.

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