RAC Appeals: How to Successfully Manage the Process (Audio Conference)

Live audio conference

Sponsored by the Revenue Cycle Institute

Tuesday, October 28, 2008
1:00-2:30 p.m. (Eastern)
12:00-1:30 p.m. (Central)
11:00-12:30 p.m. (Mountain)
10:00-11:30 a.m. (Pacific)

A finding in the recent Recovery Audit Contractor report shows that only 14% of hospitals appealed RAC determinations during the demonstration project. This low percentage is likely due to fact that hospitals lacked the infrastructure to track and manage appeals. That is changing. The RAC program goes nationwide by 2010. You need a well-prepared response team to determine appropriate appeals, meet relevant deadlines, and track the process.

During this 90-minute audio conference, you'll learn how to respond when a RAC makes an overpayment determination and how to navigate the five levels of appeal. You'll find out how to form an effective in-house response team, what to do following receipt of a notification letter, and which criteria to use when determining whether to appeal.

This is an intermediate-level program. Participants should have a basic understanding of the RAC program.

TAKE A LOOK AT THE AGENDA:

1. Update on RAC program
2. Appeal steps:
1. Prologue
• 15-day rebuttal process with RAC
• Denials sent to Medicare administrative contractor (MAC), fiscal intermediary (FI), or carrier for adjustment
2. Five levels of appeal
• First level: MAC, FI or carrier internal appeal
• Second level: Qualified Independent Contractor (QIC)
• Third level: Administrative Law Judge
• Fourth level: Medicare Appeals Counsel
• Fifth level: U.S. District Court
3. Track appeals
1. Process to determine when/when not to appeal
2. Build a tracking mechanism that ensures interoperability with financial and registration systems
3. Select members of a RAC team
4. Share information with CFO and medical staff
4. Perform proactive audits
1. Categories that prompt denials
2. Reviewing records, mining databases
5. Process appeals: Case study approach
1. HIM and case management collaboration

A live question and answer session follows the presentation.

LEARNING OBJECTIVES

• Explain what RACs are, how they function, and the financial impact
• Implement an action plan to prepare for a RAC audit and denial appeal
• Implement a process to manage the appeals process
• Identify the five levels of appeal
• Explain criteria to determine the appropriateness of an appeal

MEET THE SPEAKERS

Kathy M. Johnson, RHIA, is director of coding services at Care Communications, Inc. (CARE) in Chicago, IL.

Jackie Birmingham, RN, BSN, MS, CMAC, is vice president for professional services, Curaspan Health Group, Inc./eDischarge, based in Newton, MA.

BONUS TOOLS INCLUDED IN YOUR MATERIAL PACKET

In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and copies of a sample report to medical staff. These materials will be provided prior to the program date via e-mail with PDF links. Please download the PDF files before the start of the program.

CONTINUING EDUCATION CREDITS

This program has prior approval of the American Academy of Professional Coders for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor. Credits expire October 31, 2009.

This program has been approved for 1.5 Continuing Education Units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Credits expire December 31, 2008.

WHO SHOULD LISTEN?

HIM and medical records directors, revenue cycle directors and managers, compliance officers and director, hospital business office staff, coding staff, and case managers.

DIAL IN TOLL FREE

Details on how to call will be sent to you via e-mail with your materials package.

AUDIO ON-DEMAND

In addition to the regular participation options for HCPro audio conferences—live, CD, or combination packages—we are pleased to offer another option, audio on-demand. This option allows you to download the program and play it back at your convenience through your computer or MP3 player.

CAN'T LISTEN LIVE?

No problem. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.

PRICING