RAC Compliance Update - 2013

Event Information
Product Format
Prerecorded Event
Presenter(s)
Duane Abbey, Ph.D.
Length
90 Minutes
Product Description

Brush Up On 2013 RAC Update and Issue Areas for Recoupment

It’s vital to know the status of CMS efforts with pre-payment audits and the key issues where the RACs are finding the greatest recoupment.

Register for this 90 minute audio session with Duane C. Abbey, Ph.D., CFP to know what to do about the ambiguous guidance from the Medicare program, when will the RACs start using statistical extrapolation to determine alleged overpayments, and why do the RACs discover so few underpayments. Duane will share the documentation requirement that will satisfy the RAC auditors and useful ways of accommodating RAC issues with general compliance plan.

Duane will offer insights on RAC activities, approved RAC audit issues, operational challenges under the RACs, and developing issues that hospitals and clinics should consider in their compliance and auditing activities. Plus, he’ll address associated MAC auditing activities.

The objective of this session is:

  • To Review Current RAC Activities.
  • To Address General Operational Concerns.
  • To Understand Medical Necessity Issues.
  • To Review Issues Currently Being Added to the Approved Lists.
  • To Discuss Possible Future Issues and How to Prepare.
  • To Appreciate Ambiguous Guidance from Medicare and the RAC Impact.
  • To Appreciate the Role of Extrapolation In RAC Audits.
  • To Assess General Compliance Activities Relative to RAC Audits.
  • To Work Through Several Brief Case Studies to Illustrate Problem Areas.

Take a look at the topics covered:  

  • CMS RAC Program
    • Objectives of the RAC Program
    • Very Brief History and Status of the Program
    • Major Issue Areas for Recoupment
    • Associated Audit and Compliance Programs
  • RAC Update
    • Amounts Recouped
      • Underpayments
      • Overpayments
    • Geographical Differences
  • RAC Issues
    • Approved Issues
    • Trends in Identification of Issues
    • Frequency of Appeals
  • Medical Necessity Issues
    • Problem DRGs
    • Observation Issues
    • Subjective Nature of Medical Necessity Denials
    • Identified RAC Audit Areas for DRGs and Observation
  • Anticipated Future Issues
    • Provider-Based Rule and Physician Supervision
    • DRG 3- Day Payment Window
    • Technical Component E/M Levels
    • “-25” and “-59” Modifier Utilization
  • RAC Utilization of Extrapolation Process
    • What is Extrapolation
    • Where Will the RACs Use Extrapolation?
  • RAC and MAC Pre-Payment Audits
  • Case Studies
  • Sources for Further Information

Who should attend? 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, All Other Hospital Personnel Interested in Compliance

Order Below or Call 1-866-458-2965 Today

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1-866-458-2965

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About Our Speaker

Duane Abbey

Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in health care consulting and related areas. Abbey earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years experience as a consultant. He performs various financial analysis, including business structuring, organizational development, enrollment, and other financially related concerns of an organization. Abbey's consulting...   More Info
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