With the auditing powers of Recovery Audit Contractors—or RACs—expanding in depth among all 50 states, millions of dollars are at stake for hospitals and other facilities in payments made to Medicare. As of January 1, 2010, RACs can now request to review medical records, which puts a burden on facilities and will likely lead to greater money recouped from CMS.

Improving compliance and creating a fluid workflow can not only help prevent RAC audits, but it has the dual benefit of improving patient care and creating a more efficient system in your facility.

Join the publisher of Case In Point, Case In Point Weekly and the Case Management Resource Guide for an online training session and learn what you and your organization can do to safeguard against RACs, including:

Continuing education credits have been applied for nurses, case managers and disability management specialists.

About the Webinar

As of January 1, 2010, the Recovery Audit Contractor Program, which seeks to correct errors in Medicare payments due to flawed billing, coding mistakes and medical necessity, is underway in all 50 states. Recently, RACs have begun to issue complex reviews, which require a hospital’s unveiling of medical records, in addition to the now-standard automated reviews that deal primarily with claims data.

Thus far, RACs have uncovered nearly $1 billion in medical overpayments that providers have been forced to repay to Medicare. And as complex reviews become more common, experts predict that number to rise dramatically. The key to preventing costly audits, according to experts, centers on competent and well-defined workflow, which can boost the level of compliance within an organization.

This training session offers implementation guidelines, real working examples of successful compliance programs, and a look at the pivotal role of physician advisors in workflow processes and medical necessity needs, in order to cover what organizations need to know about RACs and how to take steps to avoid them.

Background Information

While Medicare audits are not new in principle, the concept of independent agencies contracting with the government insurance program—and gaining a percentage of flawed reviews—became practice with The Medicare Modernization Act of 2003, which established RACs in a demonstration project. Under this program, RACs could review claims in a variety of service types, like durable medical equipment, hospital inpatient and outpatient, and skilled nursing facility. Evaluating medical necessity and medical records, among other criteria, the RACs recovered more than $990 million of overpayments, according to a 2008 CMS report.

In 2006, The Tax Relief and Health Care Act made the program permanent, with 2010 the deadline for national adherence. With the foreknowledge of this expansion, many organizations have begun developing internal systems to not only handle the workflow that a RAC audit demands but to emplace tools that will prevent reviews from upturning inconsistencies in the first place.

The RAC expansion operates under a four-quadrant breakdown of the U.S.—northeast, south, midwest and west. Each section is covered by a permanent contractor, which can conduct two kinds of reviews on a targeted organization. The automated review, which has been in practice since early in 2009, is based on claims data that show obvious signs of irregularities, like impossible numbers or duplicate billing. Complex reviews, the more anxiety-provoking and labor-intensive kind, will begin in January in what will typically involve the unveiling of medical records. Contractors can request up to 200 records per national provider identifier every 45 days.

Our Webinar Will Answer These Questions:

• What are RACs?
• Where do they operate?
• Which contractors operate in my region?
• Why is my hospital or facility being targeted?
• What is the difference between automated and complex reviews?
• What can I do to limit the chance of a RAC audit?
• What have case management programs done to improve workflow?
• What have clinical documentation specialists done to improve documentation proactively?
• How can I implement a RAC risk assessment model?
• How can I improve clinical documentation to support treatment options?
• What happens if my facility is audited?
• How do I best identify medical necessity?
• What is the urgent call for medical necessity guidelines?
• What tools can my facility implement to improve workflow?
• What software exists to improve workflow?
• How can a physician advisor aid a facility’s adherence?
  
  
  

Speakers:

	Jeanine Tome, RN-BC, MSN, ACM, CPHQ Chief Clinical Officer, Allscripts Care Management
	Patty K. Scott, MSNA, RN, RHIA, CPHQ, CPMSM Vice President, Quality/Case/Risk Management and Regulatory Compliance IASIS Healthcare Corporation
	Michael Taylor, MD Senior Medical Director of Government and Regulatory Affairs Executive Health Resources
	Moderator: Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN Editor in Chief, Case Management Products Dorland Health, a Division of Access Intelligence

Who Should Attend

• Advanced Registered Nurse Professionals
• Case Managers
• CEOs
• CFOs
• Billing Personnel
• Clinical Documentation Specialists
• Skilled Nursing Administrators
• Rehabilitation Directors
• Coders
• Compliance Officers
• Medical Directors
• Medical Providers
• Office Nurses
• Risk Managers
• Utilization Review Personnel
• Medical Management Supervisors
• Physicians (in all specalties)
• Physician Assitants
• Registered Nurses
• Quality Management Professionals
• Safety Officers
  

Purchase Options

Live Webcast Registration – $329

Webcast Recording on CD-ROM – $329

Live Webcast and CD-ROM – $389

Questions?

To register by phone, contact the marketing department at 301-354-1610.

If you are having any technical difficulties or need assistance meeting these requirements, please contact our Technical Support Center at 1-866-709-8255 or email tsc@talkpoint.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

For content questions regarding this Webinar, contact Anne Llewellyn at 954-254-2950 or email allewellyn@dorlandhealth.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 *Dorland Health does not offer any refunds for the webinar.  All sales are final.

How does the Webinar work?

The live audio is delivered to your location over the telephone or your computer speakers. The Power-Point presentations are presented over the Internet and are available to print out before the program. This is like a talk-radio program with visuals on the Web. You and your team will be able to have a live Q&A with all the speakers.

More details on equipment and connections