WEBINAR: RAC Update for 2017

This webinar is devoted to reviewing the current status of RAC activities along with due consideration to the new contracts, Scope or Works, and various RAC approved issues.

Included will be recent events surrounding the RACs and the backlog of appeals at the ALJ (Administrative Law Judge) and MAC (Medicare Appeals Council) level.  There are currently hundreds of thousands pf pending appeals.  OMHA (Office of Medicare Hearings and Appeals) has indicated that at least two years will be necessary 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.  The QIOs (Quality Improvement Organizations) are also becoming involved with short-inpatient stays and the ‘Over 2-Midnights’ rule.  CMS has also proposed changes to the appeals process in order to expedite the resolution of the backlog of appeals.

Webinar Objectives: 
review current RAC activities
review the different SOWs for the Five Regions
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
review CMS Proposed Changes in the Appeals Process
assess the impact of the Backlog both Operationally and Financially
review how OMHA (Office of Medicare Hearings and Appeals) is reacting to this situation
discuss one of the main issues causing the Backlog – Hospital Inpatient Admissions vs. Observation Services
review the Settlement Process and Administrative Agreements
discuss the OMHA Proposal to use Statistical Extrapolation
review the ‘Over 2-Midnights’ Rule and the Subregulatory Guidance being issued including QIO involvement
appreciate common Physician Hospital Services and Associated Billing
delineate current and anticipated Physician Issues
review current and anticipated Hospital Issues

Webinar Topics:
  - 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
Additional Special Issues
  - Pre-Payment Audits
  - Issues Involving Statistical Extrapolation
  - CMS Improvements in the RAC Process
Sources for Additional Information

Target Audience:
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

Faculty: Duane C. Abbey

Duane Abbey A management consultant and president of Abbey & Abbey Consultants, based in Ames, Iowa. For over twenty years Abbey & Abbey, Consultants, Inc. has provided superior healthcare consulting services to hospitals, hospital systems, physicians, medical clinics and integrated delivery systems.

Abbey & Abbey, Consultants, Inc. specializes in healthcare consulting primarily in the areas of: 
Payment systems - reimbursement consulting
Delivery systems - organization of healthcare delivery
Compliance - developing compliance programs - emphasis in the coding, billing and reimbursement areas

In addition to his consulting, Dr. Abbey has been an invited presenter for hospital associations, medical societies, and other groups. He has also published both articles and books on health care topics. Dr. Abbey earned his graduate degrees from the University of Notre Dame and Iowa State University.

Attendance Hours: 
All participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate.
4/12/2017 10:00 AM - 4/12/2017 11:30 AM
United States

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