RACs and Medical Necessity: Limit Recoupments and Appeal Successfully
Product Description:
AUDIO CONFERENCE ON CD or AUDIO ON-DEMAND
Sponsored by The Revenue Cycle Institute
presented on February 22, 2010
With RAC medical necessity audits scheduled to begin in early 2010, your facility needs to have a plan in place to reduce denials. During this 90-minute audio conference, our expert speakers clarify anticipated RAC targets, and provide specific strategies to minimize denials or successfully appeal them when necessary.
LEARNING OBJECTIVES
At the conclusion of this audio conference, you will be able to:
- Describe the regulatory framework surrounding medical necessity
- Recognize common medical necessity issues identified in the RAC demonstration program
- Identify probable RAC medical necessity targets for the permanent program
- List other government auditors targeting medical necessity
- Describe strategies to reduce RAC medical necessity denials
AGENDA
- Regulatory framework
- Define medical necessity and determine patient status
- Understand CMS guidance on evidence-based medicine in the inpatient decision process
- Manage utilization review
- RAC program targets
- Orders for inpatient-only procedures
- Susceptible procedures such as cardiac, chest pain, and back pain
- Common medical necessity targets for other auditors
- MAC audits
- QIO monitoring
- The role of the new PEPPER
- Strategies to protect against RAC medical necessity denials
- Concurrent review process
- Techniques for appealing medical necessity denials
- Screening criteria
A question and answer session follows the presentation.
MEET THE SPEAKERS
Kimberly Anderwood Hoy, JD, CPC, is director of Medicare and compliance at HCPro. She is a lead consultant for the company's Revenue Cycle Institute and is lead instructor for Medicare Boot Camp® - Hospital Version. She is a former compliance officer and hospital in-house legal counsel.
Joseph Zebrowitz, MD, is executive vice president of Executive Health Resources (EHR) where he was instrumental in developing the company's suite of clinical revenue cycle management solutions. He regularly conducts educational sessions and has completed hundreds of regulatory assessment audits for EHR's hospital clients, and oversees EHR's education and regulatory assessment teams.
WHO SHOULD LISTEN?
Revenue cycle managers/directors, finance managers, HIM directors, case managers/utilization review, compliance officers, auditors, physician advisors, and CDI specialists.
MATERIALS
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and:
- Checklist to ensure an effective program
- Diagrams on the pre-appeals process
- Medicare appeals process chart
These materials are provided with PDF links.
AUDIO ON-DEMAND
In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. 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.
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