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CMS Issues 2022 MPFS and QPP Proposed Rule | Holland & Knight LLP

CMS Issues 2022 MPFS and QPP Proposed Rule | Holland & Knight LLP
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MCIT Breakthrough Devices Program Coverage Delayed

On May 14, 2021, CMS issued a new final rule that will further delay the effective date of the Medicare Coverage of Innovative Technology MCIT and Definition of Reasonable and Necessary Final Rule until no earlier than Dec. 15, 2021. ....

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ZPIC Audits: What Healthcare Providers Need to Know | Oberheiden P.C.

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Zone Program Integrity Contractors (ZPICs) are federal contractors that work under the direction of the Centers for Medicare and Medicaid Services (CMS) to uncover fraudulent billings under Medicare. ZPICs have broad authority to conduct audits of Medicare-participating healthcare providers; and, following audits, ZPICs can directly impose sanctions and/or refer providers to CMS or the U.S. Department of Justice for further enforcement action.
Technically, ZPICs are tasked with identifying both overpayments and underpayments. Their “integrity” function is intended to ensure that both CMS and the providers that bill Medicare achieve fair outcomes. However, as “fee for service” contractors working with CMS, ZPICs are only financially incentivized to identify overpayments and seek recoupments, and this means that ZPIC audits usually only focus on determining whether these contractors can lodge accusations o ....

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