On September 30, 2010, the Centers for Medicare and Medicaid Services (CMS) awarded SafeGuard Services, LLC, (SGS) the Zone Program Integrity Contract (ZPIC) for Zone 1. The ZPIC is CMS' new approach to Program Integrity work. CMS divided the country into seven zones. Zone 1 consists of California, Hawaii, Nevada, Guam, American Samoa, the Northern Mariana Islands, Palau, Marshall Islands, and the Federated States of Micronesia. Within each zone, the ZPIC Contractor will have responsibility to detect and prevent fraud in Medicare Parts A, B, Durable Medical Equipment, Prostheses, Orthotics, and Supplies (DMEPOS), Home Health and Hospice, and a Medi-Medi data match.
Beginning in September 2011, CMS gave providers a new mechanism for submitting medical documentation. This new mechanism is via Electronic Submission of Medical Documentation (esMD) system. Providers may now have the option to electronically send requested medical documentation to the requesting review contractor via esMD through a CMS certified Health Information Handler (HIH). There are several benefits of esMD for the provider. One is that there is an electronic trail and a report that indicates when the entity has received medical records. Sending electronic files via a secure connection directly to the recipient is safer. Other benefits are the reduction of paperwork and costs to all. Zone 1 has begun accepting requested medical documentation for prepay/post-pay reviews through esMD via CMS certified Health Information Handlers (HIH). Safeguard Services, LLC does not accept direct submissions for requested documentation. For more information about esMD, please refer to the CMS website at www.cms.gov/esMD.
SGS develops strong working relationships with CMS, Law Enforcement, State agencies, Medicare Administrative Contractors (MAC) and fellow ZPICs and PSCs. We will maintain and expand these relationships as we work together to protect the integrity of the Medicare Trust Fund.