RAC Update and New Issues for 2017

Event Information
Product Format
Prerecorded Event
Presenter(s)
Length
90 minutes
Product Description

RAC Update 2017: OMHA and CMS Proposal on Clearing Appeals Backlog, Medical Necessity for Inpatient Admissions and More!

With hundreds of thousands of pending appeals at the Administrative Law Judge (ALJ) and Medicare Appeals Council (MAC) levels, the Office of Medicare Hearings and Appeals (OMHA) has indicated that at least two years would be required to address current appeals. OMHA has also proposed several different ways for addressing the enormous backlog that includes administrative agreements, settlement conferences, and statistical extrapolation

Another pressing issue is the Medical necessity for inpatient admissions. These issues have sparked the development of the ‘Over 2-Midnights’ rule. The Quality Improvement Organizations (QIOs) have also been involved with short-inpatient stays and the ‘Over 2-Midnights’ rule. To expedite the resolution of the backlog of appeals, CMS has also proposed changes to the appeals process.

Join this On-Demand Webinar with expert speaker Duane C. Abbey, Ph.D., who will review the current status of RAC activities, focus on the new contracts, Scope of Works, and various RAC approved issues. During the presentation, he will discuss recent events regarding the RACs and the backlogs of appeals at the Administrative Law Judge (ALJ) and Medicare Appeals Council (MAC) level.

Session Highlights:

  • What’s the current status of the RAC program?
  • Why are there so many appeals at the ALJ/MAC level?
  • Whether there been a change in the Scope of Work for the new RAC contracts?
  • How has Office of Medicare Hearings and Appeals (OMHA) reacted to the flood of appeals?
  • How will the delays in the appeals process affect our physicians and/or hospitals?
  • Whether the OMHA can use statistical extrapolation to address the backlog?
  • Who are the new RACs?
  • What are ‘Settlement Conferences’?
  • Why is there an increase in the number of issues for physicians?
  • How should the hospitals and physicians work to have appropriate inpatient admissions?
  • What are the key issues for the RACs to find the greatest recoupments?
  • What’s all the fuss regarding the ‘Over 2-Midnights’ rule?
  • What happens when a hospital inpatient denial occurs? Whether it affects physician coding and billing?
  • Why was the involvement of the QIOs in the ‘Over 2-Midnights’ rule by the CMS?
  • What do physicians need to document to justify hospital services?

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
      • Sub-regulatory 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
  • Additional Special Issues
    • Pre-Payment Audits
    • Issues Involving Statistical Extrapolation
    • CMS Improvements in the RAC Process
  • Sources for Additional 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
  • Clinic Managers/Administrators Utilization Review Personnel
  • Medical Staff Organization Personnel
  • Physicians, Non-Physician Practitioners
  • All Other Hospital Personnel Interested in Compliance and RAC Activities

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

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