Catalog Number : cca1633
Title : RAC Compliance Update
Speaker : Duane Abbey

Webplay Recording Date : 5-13-2015
Webplay Price : $ 125 for two weeks viewing

Webinar Description:

This webinar is devoted to reviewing the current status of RAC activities along with due consideration to the new contracts, Scope or Works, and various RAC approved issues. Included will be recent events surrounding the RACs and the backlog of appeals at the ALJ (Administrative Law Judge) and MAC (Medicare Appeals Council) level. There are currently hundreds of thousands pf pending appeals. OMHA (Office of Medicare Hearings and Appeals) has indicated that at least two years will be necessary to address current appeals. OMHA has proposed several different ways to address the enormous backlog including statistical extrapolation, settlement conferences, and administrative agreements. One of the main issues is that of medical necessity for inpatient admissions. The inpatient issues has sparked the development of the 'Over 2-Midnights' rule. The QIOs (Quality Improvement Organizations) are also becoming involved with short-inpatient stays and the 'Over 2-Midnights' rule. CMS has also proposed changes to the appeals process in order to expedite the resolution of the backlog of appeals.

Webinar Objectives:

• review current RAC activities
• review the different SOWs for the Five Regions
• review the overall RAC Appeals Process
• understand the role of the Administrative Law Judges and the Medicare Appeals Council
• discuss the enormous backlog of Appeals at the ALJ/MAC level
• review CMS Proposed Changes in the Appeals Process
• assess the impact of the Backlog both Operationally and Financially
• review how OMHA (Office of Medicare Hearings and Appeals) is reacting to this situation
• discuss one of the main issues causing the Backlog - Hospital Inpatient Admissions vs. Observation Services
• review the Settlement Process and Administrative Agreements
• discuss the OMHA Proposal to use Statistical Extrapolation
• review the 'Over 2-Midnights' Rule and the Subregulatory Guidance being issued including QIO involvement
• appreciate common Physician Hospital Services and Associated Billing
• delineate current and anticipated Physician Issues
• review current and anticipated Hospital Issues

A few of the topics that will be covered:

• Overview
  • Objectives of the RAC Program
  • Objectives of Other Federal Auditing Programs
  • Emphasis on Hospital Recoupment o Growing Number of Issues for Physicians/Clinics
  • Common Issues for Physicians and Hospitals
• New RACs and Associated SOWs
  • Five New RACs
  • Guidance from the SOWs
  • Possible Differences in Prioritization of Issues
• RAC Appeals Process
  • ALJs - Administrative Law Judges
  • MAC - Medicare Appeals Council
  • Specific Timelines Within the Appeals Process
  • How are Recoupments Handled?
• Current Backlog of Appeals at the ALJ/MAC Level
  • Number of Appeals
  • Rate of Appeals Reaching the ALJ/MAC Level
  • General Categories of Appeals
  • OMHA's Reactions and Operational Plans
• CMS Proposed Changes to the Appeals Process
  • Increased Use of Attorneys
  • Streamlining Processes
• Major Concern for RAC Denials of Inpatient Admissions
  • What Constitutes and Inpatient Admission?
  • How Inpatient Is Different From Observation
  • The 'Over 2-Midnights' Rule
    • Subregulatory Guidance
    • Medical Staff Training and Guidance
    • RAC Involvement
    • QIO Involvement
• OMHA Proposals to Resolve Backlog
  • Statistical Extrapolation
  • Administrative Agreements
  • Settlement Conferences
• Trends in RAC Audit Issues
  • Physicians o Hospitals
  • Crossover Issues for Hospitals and Physicians
• Additional Special Issues
  • Pre-Payment Audits
  • Issues Involving Statistical Extrapolation
  • CMS Improvements in the RAC Process
• Sources for Additional Information

Target Audience:

Chief Compliance Officers, CBR Compliance Officers, Healthcare Auditors, Healthcare Compliance Personnel, Chargemaster Coordinators, Billing and Claims Generation Personnel, Patient Financial Management Personnel, Cost Accounting Personnel, Cost Report Personnel, Financial Analysts, Managed Care Contract Personnel, Revenue Enhancement Personnel, Chief Financial Officers, Chief Compliance Officers, Financial Planners, Clinic Managers/Administrators Utilization Review Personnel, Medical Staff Organization Personnel, Physicians, Non-Physician Practitioners, All Other Hospital Personnel Interested in Compliance and RAC Activities

Attendance Certificate:

All participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program

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.