ZPIC Record Preparation

It is common practice for providers to receive communications from Governmental review agencies and Managed Care Plans requesting proof of the provision of skilled services in the form of Additional Documentation Request (ADR), Help Letters, and Common Working File requests. Most recently, these paper audits have evolved into on-site reviews combined with facility staff observation and interview.

A Zone Program Integrity Contractor (ZPIC) Audit is a highly specialized audit where CMS is attempting to detect, deter and prevent Medicare fraud and abuse. Kris B Harmony (KBH) devised a unique approach to preparing and submitting medical record documentation in response to ZPIC inquiries.

Our HealthCARE Specialists help develop patient-specific Proper Reimbursement Explanation Paper (PREP) letters. These letters detail, describe and reference the rationale for skilled services and enhance the reviewer's understanding and justification of services provided. While completing the above process, KBH simultaneously identifies possible risk areas and causes for review. At this time, prevention strategies can be implemented at the provider level.

How can Kris B Harmony (KBH) help?

Kris B Harmony (KBH) can assist with the following:

  • Review the facility’s current policy and procedure related to the RAI process as it relates to MDS, Care Area Assessment completion and Care plan development
  • Assessment of compliance with the OBRA regulations for timely completion and submission of  the MDS
  • Validation of MDS accuracy through record review, direct resident observation and staff interviews with a focus on key risk areas, including ADLs, Skin conditions and Falls  
  • Interview staff responsible for MDS completion to assess knowledge of coding instructions, identify education needs, and perform focused training
  • Review of facility processes to determine the effectiveness of the Care Area Assessment (CAA) process in linking the MDS to a care plan that involves an interdisciplinary team including the direct care staff and the resident
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