germanvilla.blogg.se - Upic resources

#UPIC RESOURCES MAC#

leads, vulnerabilities, concepts, approaches) with other UPICs/ZPICs to promote the goals of the program and the efficiency of operations at other contracts and

Identify the need for administrative actions such as payment suspensions, prepayment or auto-denial edits, revocations, postpay overpayment determination.

Perform data analysis in coordination with CPI's Fraud Prevention System, IDR and OnePI.

Perform medical review, as appropriate.

Conduct investigations in accordance with the priorities established by CPI's Fraud Prevention System.

Investigate potential fraud and abuse for CMS administrative action or referral to law enforcement.

Actions the UPICs take to detect and deter fraud, waste, and abuse in the Medicare program include:

#UPIC RESOURCES MAC#

They also identify any improper payments that are to be recouped by the MAC (Medicare Administrative Contractor). They develop investigations early, and in a timely manner, take immediate action to ensure Medicare Trust Fund monies are not inappropriately paid. UPICs primary goal is to investigate instances of suspected fraud, waste, and abuse in Medicare or Medicaid claims. The UPICs, ZPICs and the MEDIC work under the direction of the Center for Program Integrity (CPI) in CMS.

Medicare Part C and D program integrity efforts are handled separately by one national contractor known as the Medicare Drug Integrity Contractor (MEDIC). UPICS were created to perform program integrity functions for Medicare Parts A, B, Durable Medical Equipment Prosthetics, Orthotics, and Supplies, Home Health and Hospice, Medicaid and Medicare-Medicaid data matching. Safeguard Services is the contractor selected by CMS for the North-Eastern Unified Program Integrity Contractor (UPIC) region.