MEDICARE RAC Certificate Program

One of the most significant changes in the Medicare pro- gram recently has been the introduction of "recovery audit contracting" (RAC) as a way of assuring that proper payments are being made for Medicare services. In the new RAC model, contractors are incentivized with contingency fees to find and recoup improper overpayments to providers of Medicare services. (Providers of course benefit from the identification of underpayments as well, but these represent a very small part of the action.)

Based on the success of the RAC demonstrations authorized by Section 306 of the Medicare Modernization Act of 2003, the RAC process is now back on track for permanent and nationwide implementation, as required by Section 32 of the Tax Relief and Health Care Act of 2006. On October 1, 2008 CMS announced the four contractors who will manage the permanent program in four respective geographic regions; and on February 4, 2009 CMS announced that the parties involved in the protest of those contractor awards had reached a setlement and that national implementation would resume.

CMS had made a number of changes based on lessons learned in the demonstration regarding RAC contractor staff expertise, limits on records, customer service and transparency requirements, and oversight. But concerns remain. Is the time-table still too ambitious? Will the demands for records still be burdensome? Are the contingent fees a proper incentive or could they provide a perverse incentive for "bounty hunting" and over-zealous auditing behavior? And even with the changes, is there enough oversight of the contractors themselves and enough transparency in the process? These and other issues will be explored in depth at the Second National RAC Summit, together with a pre-conference RAC "Boot Camp" and Certificate Program for those who want to take a deeper dive into the subject matter. Finally, the Summit will continue to break new ground by permitting registrants to enjoy the complete Summit experience on line through both real-time and archived access to all Summit presentations.

• Provider Corporate Compliance Officers and Staff
• Coding Professionals
• Billing and Finance Office Staff
• Health Information Management Professionals
• Appeals Management
• Utilization Review/Utilization Management Staff
• Nursing and Medical Staff Members
• Hospital and Nursing Home Admission and Discharge Personnel
• Corporate Ethics Staff
• Legal Counsel for Providers and Medicare Suppliers
• Health System and Hospital Executives and Senior Managers
• Physician Group Executives and Medical Directors
• Nursing Home, Home Health Agency, and Hospice staff
• Laboratory, Durable Medical Equipment, and Ambulance Representatives
• Federal Agencies, including CMS, HHS OIG, and GAO
• Congressional Staff
• Law firms specializing in Medicare regulations and appeals
• Vendors and Consulting Firms with Products, Services and Solutions to Assist in Preparing for, Responding to, and Appealing RAC Audits