MEDICARE RAC Certificate Program
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The burden of hospital audits by RAC and MAC contractors in Medicare has never been greater, and the level of uncertainly never greater than under the current "two midnight rule" which keeps being "clarified" by CMS. States are also ramping up their own Medicaid RAC contractors, and Medicare Advantage plans and now commercial insurers are adopting aggressive auditing tactics to compound the burden on hospitals. Hospitals' rightful appeals of this growing body of denials in turn has 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. 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 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 whether internal, external or hybrid
- how to construct an effective partnership between the PA and UR two functions to ensure proper documentation and site of service
- best practices on documentation, certification, rounding, physician education and appeal strategies
The focus will be on all steps in the process -- (1) setting up a PA program; (2) the first point of contact and role of UR; (3) documentation to support the correct status; (4) preventing a pattern of denials; and (5) appeal strategies.
The Boot Camp will also include a specific preconference on attacking the two midnight rule to round out the training. 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, hands-on, highly interactive experience for hospital leaders and managers. 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 colleagues at the end of Day I, set up single issue breakfast table topics on the morning of Day II, and assign homework in the form of case studies about inpatient vs. observation 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:
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- 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)
- 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 or 3 or more) before May 2 for $595 each. Estimate the cost of registration, travel, and a hotel group rate of $152 against the cost of one denied inpatient claim. (See the word "ROI" above.) Join us in Chicago. This might be your best hospital investment in 2014.
