Updated on: November 29, -0001

CMS to Fold ZPICs and MACs into New UPIC Entities

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Original story posted on: July 31, 2013

The Centers for Medicare & Medicaid Services (CMS) reportedly is developing a new integrity contractor called a Unified Program Integrity Contractor (UPIC).

These contractors will focus on both Medicare and Medicaid integrity issues, and the Zone Program Integrity Contractors (ZPICs) and the Medicare Administrative Contractors (MACs) will be folded into the UPICs, according to an email sent last Friday by Dianne De La Mare, vice president of legal affairs for the American Health Care Association (AHCA).

De La Mar was reporting on what she described in her email as a conference call held last Friday by CMS Program Integrity. She added that MACs would not be going away; however, their integrity responsibilities will be folded into those of the UPICs.

A CMS spokesman subsequently offered clarification on the content of De La Mar's email, noting that not all ZPIC or MAC work is expected to be absorbed by the new UPICs.

"We expect the scope of work for the UPICs will encompass many of the functions that are currently performed by several contractors – this includes Zone Program Integrity Contractors (ZPICs, and their Medicare-Medicaid data match responsibilities), Program Safeguard Contractors (PSCs), and the Medicaid Integrity Contractors (MICs)," the spokesman wrote.

"CMS is currently in the initial stages of information gathering and has published a request for information (RFI) via the FBO website. We anticipate (that) the UPICs will operate, based on regional jurisdictions, as a single contractor performing audit and investigation work across a designated set of states."

Writing that the Medicaid Integrity Contractors (MICs), will be phased out, De La Mar also indicated that the recovery auditors will remain in place. Moreover, she concluded, CMS will be consolidating all of its Medicare and Medicaid data into one unified database.

Check back with www.racmonitor.com for updates to this story in the coming weeks.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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