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 improper overpayments (and underpayments) to providers of Medicare services. New RAC contractors are now being put into place by the States for the Medicaid program, heightening the potential for provider burden and contractor overlap, including overlap with State OIG initiatives and other entities targeting outright fraud.

Provider complaints about overzealous RAC contractors have now reached Congress, as have complaints about inefficient MICs in the Medicaid program and aggressive ZPICs targeting fraud in hot spots. As a result, CMS is in the process of making changes to the overall program integrity effort, with new December. The most dramatic new wrinkle in 2012 is the decision by CMS to allow the MACs to conduct prepayment review of questionable claims for medical necessity, site of service, and improper coding, preventing payment on the front end. The same authority is now available to the RACs as of August 2012. And beyond the Medicare FFS program, Medicare Advantage plans are now conducting audits and denying claims, and even some commercial health plans have contracted with the RACs to look for patterns of overpayment or even fraud.

Now in its seventh iteration, the National RAC (and MAC) Summit brings together seasoned hospital representatives, best of breed solutions companies, and savvy compliance provide very practical advice for how to get it right the first time...and what to do if you don't. The Summit continues to offer onsite and online participation, and has now added an Advanced as well as a Basic RAC Certificate Program. This year's Preconference draws on best practices from hospitals around the country to teach attendees how to create a strong Utilization Review function that works in concert with a strong Physician Advisor function, no matter the hospital size. The agenda interaction and provide practical "how to" advice on both Medicare and Medicaid issues, and on MAC as well as RAC issues. More than ever before, it is a "must" event.

• 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