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SEVENTH NATIONAL
RAC (and MAC) SUMMIT
Getting it right the first time...and what to do if you don't
December 4 - 6, 2012
ONSITE
Mandarin Oriental
Washington, DC
ONLINE
Live and Archived for 6 months
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MEDICARE RAC CERTIFICATE PROGRAM
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GRANTORS
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SILVER
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BRONZE
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ADDITIONAL GRANTORS
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ISSUES TO BE ADDRESSED
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- Changes in CMS Program Integrity Program
- The AHA Policy and Advocacy Agenda
- CMS Predictive Modeling Contractor Roles
- MAC Roles and Relationships
- What is an "Inpatient"? and How to Get It Right
- The Emergence of the Medicaid RACs
- Electronic Submissions of Audit Documentation (esMD)
- MAC and RAC Prepayment Reviews
- Medicare Advantage Plan Denials and Appeal Issues
- How to Make the Discussion Period Work for You
- Rehab and Long Term Care Issues
- The Legal Update Panel
- Building an Effective UR and PA Team
- What ALJs Look For...and How to Prepare
- RACs and Commercial Health Plans
- Current Congressional Issues and Interests
- Part A to Part B Rebilling Demonstration
- 60-day Window to Return "Identified" Overpayments
- Winning Appeal Strategies
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RAC SUMMIT BROCHURE
NOW AVAILABLE
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Click here to download the brochure.
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AHA SUES HHS OVER INPATIENT-OUTPATIENT DENIALS
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The American Hospital Association and four provider systems have filed suit in Federal court in the District of Columbia asserting that denial of payment for medically necessary hospital services when RACs claim the surgery should have been outpatient is a violation of Federal law. Click Here to view the AHA press release.
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RAC SUMMIT APPROVED FOR AAPC CEUs
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This program has the prior approval of AAPC for up to 17.0 continuing education hours, depending upon session attendance. Certificates will be issued onsite. Online attendees must enroll in, complete, and successfully pass the final examination for the Basic or Advanced RAC Certificate Program in order to earn their CEUs.
*Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.
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AHA INTRODUCES LEGISLATION TO REIN IN RACs
AHA ALSO ASKS OIG TO REVIEW RAC ACCURACY
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Reps. Sam Graves (R-MO) and Adam Schiff (D-CA) have introduced the Medicare Audit Improvement Act (H.R. 6575) to help hospitals deal with the growing burden of RAC audits. The AHA-supported legislation would improve recovery auditor transparency; restore due process rights under the AB Rebilling Demonstration; allow denied inpatient claims to be billed as outpatient claims when appropriate; and require physician review for Medicare denials. Click Here to view the AHA letter of support for the bill.
In an October 24, 2012 letter to HHS Inspector General Daniel Levinson, AHA reiterates hospitals' frustration with overlapping and burdensome audits, but also asks the OIG in FY 2013 to review the accuracy of the RACs since 75% of the denials are still being overturned. Click here to see this AHA letter.
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AMA OBJECTS TO RAC E&M CODE AUDITS
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The American Medical Association has written a strong letter to CMS Acting Administrator Marilyn B. Tavenner asking CMS to rescind the recent decision to allow RAC contractor Connolly to conduct medical reviews of CPT code 99215 for Level 5 office visits, then extrapolating their findings based on a statistical sample of such claims.
Click Here to view the AMA letter.
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LATEST AHA RAC TRAC SURVEY
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AHA has released the latest RAC Trac survey results, thorugh the second quarter of 2012.
Click Here to view the survey findings.
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CO-LOCATED WITH
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SIXTH NATIONAL PREDICTIVE MODELING SUMMIT
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A Hybrid Conference, Internet Event and Training Tool
The Leading Forum on Health Care Predictive Modeling Implications, Strategies and Solutions for Care Management, Underwriting, Profiling and Related Activities
Media Partners: Harvard Health Policy Review, Health Affairs and Predictive Modeling News
December 5 - 6, 2012
Mandarin Oriental
Washington, DC
www.PredictiveModelingSummit.com
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FREE TRIAL OFFER FOR INSIDE HEALTH POLICY
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Inside Washington Publishers is offering friends of the Seventh National RAC Summit a free four-week trial subscription to their newsletter Inside Health Policy. The free trial includes all regular subscriber services, including an e-mail alert every business day as a reminder of what's been added to the site.
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SEVENTH NATIONAL RAC (and MAC) SUMMIT
December 4 - 6, 2012
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ONSITE
Mandarin Oriental
Washington, DC
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ONLINE
In your own office or home live via the Internet
with 24/7 access for six months
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CO CHAIRS
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Ernie de los Santos
Consultant and Creator, The RAC Shadow, Los Angeles, CA |
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID |
Linda Fotheringill, Esq.
Co-Founder and Partner, Washington & West, LLC, Baltimore, MD
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Larry T. Hegland, MD
Chief Medical Officer, Ministry Saint Clare's Hospital, The Diagnostic and Treatment Center, Weston, WI |
Ryan Meade
Partner, Meade & Roach, LLP, Chicago, IL
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KEYNOTE SPEAKERS
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Rochelle Archuleta
Senior Associate Director, Policy Development, American Hospital Association, Washington, DC |
Amy (King) Caro
Vice President, Health IT Programs, Northrop Grumman Information Systems, McLean, VA |
Deanna Cruser
Provider Outreach and Education Senior Analyst - Part B, CGS Administrators, LLC, J 15 MAC, Nashville, TN
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Tara Mondock
Group Vice President, Payer Relations, IVANS, Inc. |
C. F. Moore
Deputy Chief Administrative Law Judge, Office of Medicare Hearings and Appeals, U.S. Department of Health and Human Services, Arlington, VA |
William D. Rifkin, MD, FACP, FHM
Managing Editor, Milliman Care Guidelines, New York, NY
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FACULTY FOR PRECONFERENCE ON BUILDING A STRONG UTILIZATION REVIEW AND PHYSICIAN ADVISOR FUNCTION
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Jeffrey E. Epstein, MD
Medical Director, Quality, Case Management and Resource Utilization, Stamford Hospital, Stamford, CT |
Lori Horrall, RN, BSN, MSM
Manager, Utilization Management, Union Hospital, Terre Haute, IN
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E.G. "Nick" Ulmer, Jr., MD CPC
Vice President, Clinical Services and Medical Director for Case Management, Spartanburg Regional Health System, Spartanburg, SC |
Day Egusquiza
President, AR Systems, Inc., Twin Falls, ID (Chair)
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FACULTY FOR POSTCONFERENCE ON "NO FEAR" APPEAL STRATEGIES
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Sharon Easterling, MHA, RHIA, CCS, CDIP
President and CEO, Recovery Analytics, Charlotte, NC |
Steven A. Greenspan, JD, LLM
Vice President of Regulatory Affairs, Executive Health Resources, Newtown Square, PA |
Andrew B. Wachler, Esq.
Principal, Wachler & Associates, PC, Royal Oak, MI
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Denise Wilson, MS, RN, RRT
Medicare Appeals Expert, Director, Education and Training, AppealMasters, Denial Research Group, Lutherville, MD |
Ernie de los Santos
Consultant and Creator, The RAC Shadow, Los Angeles, CA (Chair) |
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FEATURED FACULTY
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Brian Annulis
Partner, Meade, Roach, and Annulis, Chicago, IL |
Kimberly Brandt, CHC, JD
Chief Healthcare Investigative Counsel, Senate Finance Committee Minority Staff; former Counsel, Allston & Bird LLP; former Director, Medicare Program Integrity Group, CMS, Washington, DC |
Markus Cicka
Director, Missouri Medicaid Audit and Compliance, State of Missouri, Jefferson City, MO
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Brian Fisher
Program Integrity Account Manager, Iowa Medicaid Enterprise, State of Iowa Medicaid RAC and Program Integrity Contractor, De Soto, IA |
Elaine N. Foster
Health Care Manager, Utilization Review, Blue Cross Blue Shield of Michigan, Detroit, MI |
Mike Frith
Regional Manager, Patient Accounts, Trinity Health-Saint Alphonsus, Boise, ID
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Matt Kazan, MPP
Health Policy Advisor, Senate Finance Committee Majority Staff, Washington, DC |
Amy F. Lerman
Associate, Epstein Becker Green, Washington, DC |
Kathy Lippmann
Vice President, State Government Services Mid-Atlantic, HMS (State of Virginia Medicaid RAC), Richmond, VA
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Shannon Pavel, RN, CPHM
Clinical Appeals and Denials Coordinator, Infirmary Health, Mobile, AL |
Stewart M. Presser
Vice President, Greater New York Hospital Association, New York, NY |
Kathy Reep
Vice President, Financial Services, Florida Hospital Association, Orlando, FL
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Michael A. Salvatore, MD, FACP
Physician Advisor, Beebe Medical Center, Lewes, DE |
Annie Scriven
Senior Provider Relations Representative, Part A Provider Outreach and Education, CGS Administrators, LLC - Jurisdiction 15 MAC, Nashville, TN |
LJ Smith
Senior Provider Relations Representative - Part A, CGS Administrators, LLC - Jurisdiction 15 MAC, Nashville, TN
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Jane Snecinski
President, Post Acute Advisors, Atlanta, GA |
Carolyn L. Yocom
Director, Health Care, U.S. Government Accountability Office, Washington, DC
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CMS RAC INTERACTIVE MAPS
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Click below to see larger, interactive versions of the maps.
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Medicare Compliance Contractors Map
This interacrtive map shows all of the various Medicare compliance contractors, including RACs and MACs, responsible for health care entities in each State.
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State Medicaid RAC Program Status
Section 6411 of the Affordable Care Act of 2010 required States and territories to establish Medicaid Recovery Audit Contractor (RAC) programs. This interactive map summarizes the current status of each jurisdiction's RAC program, based on the information submitted in its State Plan Amendment (SPA).
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PARTICIPATION OPTIONS
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TRADITIONAL ONSITE ATTENDANCE
Simply register, travel to the conference city and attend in person.
Pros: subject matter immersion; professional networking opportunities; faculty interaction
LIVE AND ARCHIVED INTERNET ATTENDANCE
Watch the conference in live streaming video over the Internet and at your convenience
at any time 24/7 for the six months following the event.
The archived conference includes speaker videos and coordinated PowerPoint presentations.
Pros: Live digital feed and 24/7 Internet access for next six months; Accessible in office, at home or anywhere worldwide with Internet access; Avoid travel expense and hassle; No time away from the office |
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INTERNET INTERFACE SAMPLE
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Click here for a sample stream
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THE GROUP REGISTRATION/ONLINE TRAINING ALTERNATIVE
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By arranging to license online group access to the Summit Medicare RAC Certificate Program, health care providers subject to RAC audits can implement an organization-wide online Certificate Program on preparing for, responding to and appealing a RAC audit. The organization's training coordinator can assign and track online participation. Successful completion of the training can be evidenced by passing the post conference training examination.
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HERE IS AN EXAMPLE OF A HEALTH SYSTEM RAC CERTIFICATE PROGRAM
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