Catalog Number : cra1745
Title : DRGs, Medical Necessity and the RACs
Speaker : Duane Abbey

Webplay Recording Date : 9-13-2011
Webplay Price : $ 200 for two weeks viewing

Webinar Objectives:

• To List an Overview of RAC Activity Relative to Hospitals
• To Review DRGs Issues Addressed by the RACs
• To Discuss The RAC Issues Relative to Medical Necessity
• To Review the Key Role That Physicians and Their Documentation Play in the Medical Necessity Areas
• To Discuss the Different Levels In Justifying Medical Necessity
• To Review How to Prepare for Appeals Relative to Medical Necessity at Different Levels
• To Define How to Work With Physicians In Developing Complete Supporting Documentation
• To Discuss Brief Case Studies with DRGs and Observation Cases

Webinar Outline/Agenda:

• CMS RAC Program
  • Objectives of the RAC Program
  • Very Brief History and Status of the Program
  • Associated Audit and Compliance Programs
• Medical Necessity Issues
  • Problem DRGs
  • Observation Issues
  • Subjective Nature of Medical Necessity Denials
  • Identified RAC Audit Areas for DRGs and Observation
• Different Levels of Concern
  • Physician Diagnostic Statements
  • Diagnostic Justification
  • Substantiating Documentation
  • Consulting Physicians and Diagnostic Testing
  • RAC Appeals Preparation
• Working With Physicians
  • Medical Staff Organization
  • Educating and Sensitizing Physicians
  • Documentation Principles and Standards
  • Concurrent Coding and Documentation Review
  • Physician Participation in Appeals Process
• Case Studies
• Sources for Further Information

Target Audience:

• CCO
• 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
• CFO
• COO
• Financial Planner
• All other personnel interested in compliance

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.