ZPICs: Dangerous and ready to take down providers

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
Healthcare reform: No matter how much you may loathe it, there's no way around how certain ideas, like pay for performance, aren't going away.

“We don't want to believe healthcare reform is happening, but it's happening,” said Pathway Health Services vice president Lisa Thomson, BS, LNHA on Monday at the National Association of Directors of Nursing Administration/Long-Term Care keynote presentation in Nashville.

This was a far different tune than those sung by some of the politicians at the American Health Care Congressional Briefing a few weeks ago in Washington. Rep. Nan Hayworth (R-NY) said then that the House GOP's fight to repeal the Affordable Care Act was not “symbolic, because it's the will of the American people.”

Of course, politicians have a different agenda than consultants or clinical leaders. But I'd also argue that long-term care folks like presenters who give concrete ways to cope with the reality that exists today, as opposed to the future they hope would happen with a President Romney and a Republican Senate.

Still, if there is one thing that politicians, administrators, and DONs agree on, it's that Zone Program Integrity Contractors are something to be concerned about — especially if you are in Florida (Zone 7) or California (Zone 3).

If MAC and RAC contractors are seen as Godzilla or invasive aliens – scary villains that can be brought down with the right team  — than Zone Program Integrity Contractors (ZPICs) are like TV's fictional super-bad guys, Walter White or Avon Barksdale: They can destroy you easily. A big difference is, though, ZPICs will do it with data and the backing of the federal government rather than illicit drugs or guns.

Or as Thomson pointed out, “If a ZPIC sees something and sends it to the OIG [Office of the Inspector General], which sends it to the DOJ [Department of Justice], you are going into a federal investigation. You don't want to get burned.”

One facility that was the subject of a ZPIC had payment suspended for 24 months, she noted. Even a six-month suspension of payment, of course, can be the undertaker's calling card for a SNF.

It's no secret that stakeholders, especially in Florida, are pushing for ZPICs to be toned down. But if there's anything to take away from NADONA, it's Thomson's checklist of what to look out for in your facility, such as a sudden change or spike in billing, high error rates, compromised identities and RUG changes.

“You don't want ZPIC audits to happen,” she summarized succinctly.

You can see her entire presentation by clicking here. The NADONA meeting and exhibition continues through Wednesday at the Gaylord Opryland in Nashville.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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