Medicare RAC Summit: Overview

OVERVIEW

RAC Certificate Program

The burden of hospital audits by both government contractors and commercial health plans continues unabated. There is still confusion over interpretation and implementation of the "two midnight rule". States are ramping up their own Medicaid RAC contractors, and especially during the past year Medicare Advantage plans and commercial insurers are adopting aggressive auditing tactics to compound the burden on hospitals. Hospitals' rightful appeals of this growing body of denials in turn have completely overwhelmed an understaffed collection of Administrative Law Judges, and hearings are taking two years when they are even able to be scheduled. Members of Congress have heard hospital complaints loud and clear and demanded reform, MedPAC has even weighed in, and there may be a glimmer of hope in the courts.

But never has it been more important for hospitals to "get it right the first time" when it comes to proper documentation of medically necessary patient care and proper decisions regarding whether a patient meets the criteria for an inpatient admission or should be placed into Observation status or treated in an outpatient setting. This is where the Fourth National Physician Advisor and UR Team Boot Camp comes in. Over the course of three days, in a highly interactive learning environment, the Boot Camp will teach participants:

how to develop a Physician Advisor program and how the PA roles are evolving

best practices in documentation, certification, rounding, and physician education strategies

how to design and implement an integrated CDI program

how to best fight Medicare Advantage and commercial managed care plan denials

how to succeed at the ALJ level for Medicare appeals

The focus will be on the four key steps in a successful process for "Getting it Right the First Time" -- (1) The First Point of Contact; (2) Concurrent and Daily Review; (3) Denial Prevention; and (4) Ongoing Education. While the Boot Camp concentrates mostly on preventing denials, for the first time it will include a mock ALJ hearing on an actual case with an experienced former ALJ on the line to demonstrate successful preparation and presentation strategies.

The Boot Camp has become wildly popular not just for its content but also for its excellent networking opportunities -- from a formal networking reception and Q&A sessions at the end of each segment to Dutch treat dinners with faculty members and hosted informal breakfast roundtables. Especially now, when it is so important to "get it right the first time," this is a must event for hospital staff, and highly discounted rates for hospital teams make it possible for all of the right people to attend.

WHO SHOULD ATTEND

The PA-UR Team Boot Camp is designed as a very practical, handson, highly interactive experience for hospital physician advisors, clinical leaders, coding and billing managers, and other key staff involved in the critical decisions about patient status and patient flow. No just sitting around listening to talking heads. We will use an Audience Response System to do some polling and ask some questions as we go along, give everyone a short fun quiz at the end of each day, arrange for hosted informal dinners with faculty and colleagues at the end of Day II, set up single issue breakfast table topics on the morning of Day III, and assign homework in the form of case studies about inpatient vs. observation status for discussion over lunch on Day II and presentation later. Plus there are faculty panels and audience Q&A throughout.

So who should attend? Here is a non-exclusive list:

Chief Executive Officers (a good PA-UR program will save money from avoidable denials)

Chief Financial Officers (a good PA-UR program will save money from avoidable denials, maybe lots of money)

Chief Medical Officers (if you don't have a PA, learn how to recruit and train one, whether internal or external; if you do have one, learn how to make him/her more effective in partnership with your ER staff, your UR staff, your hospitalists, and your nursing staff)

Corporate Compliance Officers (learn how to make the ROI case to the three people listed above)

Hospital Corporate Counsel (learn what and when to challenge, and what works...and what doesn't)

External Affairs/Government Affairs Manager (if you have one -- you should be meeting with your Member of Congress on this stuff)

Managed care contracting staff

And of course all of the following:

RAC liaisons
staff nurses
physician advisors
utilization review committee members
case managers
emergency room clinicians
medical coding and billing staff
CDI staff
ICD10 staff
patient accounts managers
other financial and auditing personnel

But don't just send one rep. We have reduced the group discount rate for hospitals and health systems in the first Early Bird period. Send your RAC liaison, your PA, and a nurse/case manager (or any combination of 3 or more) before May 6 for $595 each. Estimate the cost of registration, travel, and a hotel group rate of $175 against the cost of one denied inpatient claim. (See the word "ROI" above.) Join us on the River Walk in San Antonio. This might be your best hospital investment in 2016.