RAC Update and New Issues for 2019

Discover What the Future of the RAC Program Holds – and How it Will Impact Your Practice

The mention of "RAC audits" can have you frantically searching for the last Aspirin prescription you took for your headache. Let’s face it: almost everyone in the healthcare sector is affected by the RAC program. And yet, most continue to remain in the dark about the key issues and objectives of the RAC program, the new RACs, the fuss about the ‘Over 2-Midnights’ rule, and what the future holds for hospitals and physicians.

Join healthcare expert Duane C. Abbey in this instructive session to catch up on the latest changes to the RAC and other federal auditing programs, as well as the status of RAC activities in the light of new contracts, scope of work, and several RAC approved issues. Abbey will also discuss the issue of medical necessity for inpatient admissions, and clearly explain the 'Over 2-Midnights' rule, including the reason behind CMS’ decision to involve the QIOs in it.

Abbey will discuss the pressing matter of the humongous backlog of appeals at the ALJ (Administrative Law Judge) and MAC (Medicare Appeals Council) level, along with recent events surrounding the RACs. You will discover the real reasons behind the endless appeals and OMHA’s (Office of Medicare Hearings and Appeals) proposal to solve them – and whether it can use statistical extrapolation to address the backlog.

You’ll learn about the five new RACs; the scope of work in the wake of the new RAC contracts, and also the key issues where the RACs are finding the greatest recoupments. This session will equip you with all there is to know about Settlement Conferences, and how physicians and hospitals should work to have appropriate inpatient admissions. There’s a lot more in store for you, so do take a quick look at the session highlights and agenda below.

Session Objectives

This session will bring you up to speed with:

• The current RAC activities
• Different SOWs for the five regions
• The role of Administrative Law Judges (ALJs) and the Medicare Appeals Council
• The RAC appeals process
• The enormous backlog of appeals at the ALJ/MAC level
• How the backlog will impact businesses operationally and financially
• How the CMS proposes to change the appeals process
• How OMHA (Office of Medicare Hearings and Appeals) proposes to resolve the backlogs
• One of the main issues causing the backlog (hospital inpatient admissions vs. observation services)
• Settlement process and administrative agreements
• OMHA proposal to use statistical extrapolation
• ‘Over 2-Midnights’ Rule and the subregulatory guidance being issued, incl. QIO involvement
• Common physician hospital services and associated billing
• How to delineate current and anticipated physician issues
• Current and anticipated hospital issues
• How to review the RACs auditing Medicare advantage programs through RADV audits

Session Agenda

• Overview
  • Objectives of the RAC Program
  • Objectives of other federal auditing programs
  • Emphasis on hospital recoupment
  • 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
  • Hospitals
  • Crossover issues for hospitals and physicians
• RAC Audits of Medicare advantage programs
  • Special features of MA programs
  • Risk adjusted payment
  • Auditing and statistical analysis through RADV
• Additional special issues
  • Pre-Payment audits
  • Issues involving statistical extrapolation
  • CMS improvements in the RAC process

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
• Clinic Managers/Administrators Utilization Review Personnel
• Medical Staff Organization Personnel
• Physicians
• Non-Physician Practitioners
• All Other Hospital Personnel Interested in Compliance and RAC Activities

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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