RAC Update and New Issues for 2016

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Review the Current Status of RAC activities and learn about RAC Updates and new issues in 2016

According to indications from OMHA (Office of Medicare Hearings an Appeals), it will take at least two years 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. Additionally, the RFP (Request for Proposal) to those that desire to be RACs along with the SOW (Scope of Work) for each the now five regions will be discussed. You will get a better understanding of health care compliance, the RACs, the OIG Work Plan and coding, billing and reimbursement compliance.

This session with expert speaker Duane C. Abbey is devoted to reviewing the current status of RAC activities along with various RAC approved issues. He will discuss the recent events surrounding the RACs and the backlog of pending appeals at the ALJ (Administrative Law Judge) and MAC (Medicare Appeals Council) level, which currently number in the hundreds of thousands.

This session will address the following questions

  • What is the current status of the RAC program?
  • What has CMS included in the RFP?
  • Why are there so many appeals at the ALJ/MAC level?
  • How will physicians and/or hospitals be affected by delays in the appeals process?
  • What has been the reaction of the OMHA (Office of Medicare Hearings and Appeals) to the flood of appeals?
  • Can the backlog be addressed by OMHA using statistical extrapolation?
  • What are these ‘Settlement Conferences’?
  • What is in the different SOWs?
  • Why have the number of issues for physicians been increasing.
  • What are the key issues where the RACs are finding the greatest recoupments?
  • What steps should physicians and hospital be taking to have appropriate inpatient admissions?
  • What is all the fuss about the ‘Over 2-Midnights rule?
  • What happens when a hospital inpatient denial occurs?  Does this affect physician coding and billing?
  • What are documentation requirements from physicians in order to justify hospital services?

Learning Objectives

  • Review of Current RAC Activities
  • Review the RFP Issued by CMS
  • Review the Different SOWs for the Five Regions
  • Briefly 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
  • Assess the Operational and Financial Impact of the Backlog
  • The OMHA’s (Office of Medicare Hearings and Appeals) Reaction to this Situation
  • Discuss Hospital Inpatient Admissions vs. Observation Services, One of the Main Issues Causing the Backlog
  • Review the Settlement Process and Administrative Agreements
  • Discuss the Use of Statistical Extrapolation Proposed by OMHA
  • Understand the ‘Over 2-Midnights’ Rule and the Subregulatory Guidance Being Issued
  • Appreciate Common Physician Hospital Services and Associated Billing
  • Delineate Current and Anticipated Physician Issues
  • Review Current and Anticipated Hospital Issues

Session Highlights

  • 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
  • RFP/SOWs
    • Main Requirements from the CMS RFP
    • Guidance from the SOWs
  • 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
  • Major Concern for RAC Denials of Inpatient Admissions
    • What Constitutes and Inpatient Admission?
    • How Inpatient Is Different From Observation
    • The ‘Over 2-Midnights’ Rule
  • 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

Order Below or Call 1-844-384-4744 Today

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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, enrolment and other financially related concerns of organizations....   More Info
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