Catalog Number : cca1576
Title : Navigating the RAC Appeals Process
Speaker : Duane Abbey

Webplay Recording Date : 6-25-2009
Webplay Price : $ 225 for two weeks viewing

Target Audience:

• All coding, billing and reimbursement staff including compliance personnel that are associated with the Medicare program and the various Medicare payment systems
• All staff members devoted to RAC activities
• Financial analysts and other interested hospital or clinic personnel

Prerequisites for Participating:

Basic knowledge of auditing in the coding, billing and reimbursement area.

Webinar Objectives:

• To review the overall RAC audit program as implemented by CMS
• To discuss the extended RAC appeal process and the various stages for appeals
• To assess when to appeal and when not to appeal
• To appreciate the need to develop organizational resources to pursue the appeals process
• To discuss the use of tracking systems relative to appeals
• To assess the use of outside consultants and attorneys in the appeals process
• To discuss the dynamic cost-benefit analysis in pursing the RAC appeal process
• To understand the skill set needed for organizations to successfully pursue the appeals process

The following are a few of the topics to be discussed:

• Brief Review of the CMS RAC Audit Program
  • Purpose and Goal
  • Operational Function
  • Issue Identification
• The RAC Appeals Process - Step-By-Step
  • Rebuttal
  • Redetermination
  • Reconsideration
  • Administrative Law Judge (ALJ)
  • Medicare Appeals Council/Departmental Appeals Board
  • Federal District Court
• Timing and Resources for the RAC Appeal Process
  • Overall Timing Considerations
  • Personnel Skills for Pursing the Appeal Process
  • Tracking Auditing and Appeals
• Financial Concerns for RAC Appeals
  • Potential Benefits
  • Costs - Operational and Organization
  • Cost-Benefit Analysis
• Future RAC Audit Issues
  • Looking to the Future
  • Expansion of RAC Audit Areas
  • Including Physicians in the RAC Audits and Appeal Process

Attendance Certificate:

Upon attending this course you will receive a 1.5 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.