MEDICARE RAC Certificate Program

One of the most significant changes in the Medicare program 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 settlement and that national implementation would resume.

CMS has 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. These changes, and new issues, will be discussed in the context of hospitals' experience, lessons learned, and advice as the national RAC program unfolds. The results of the GAO study of RAC implementation, previewed at the first Medicare RAC Summit, will also be presented.

But there is a larger program integrity agenda in play, and the Summit will also zero in on the most important components of that agenda for hospitals as well. Individual sessions will highlight the role and responsibility of the MACs, the audit MICs, and the ZPICS, and attendees will hear from the HHS Office of the Inspector General on its plans for FY 2010 and beyond.

The Summit offers a preconference RAC "Boot Camp" for those newer to the program or wishing to refresh their knowledge, as well as a Medicare RAC Certificate Program for those who want to take a deeper dive into the subject matter. Finally, the Summit continues to break new ground by permitting registrants to enjoy the complete Summit experience online 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