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National Healthcare Compliance Audioconference:
Strategies to Prepare for CMS Recovery Audit Contractors "RAC" Audits


Tuesday, May 13, 2008
1:00 pm - 2:30 pm (Eastern)
12:00 pm - 1:30 pm (Central)
11:00 am - 12:30 pm (Mountain)
10:00 am - 11:30 am (Pacific)

AUDIOCONFERENCE FACULTY

Kathleen Houston Drummy, Esq.
Partner, Davis Wright Tremaine LLP, Los Angeles, CA

Timothy B. Hill, MPA
Chief Financial Officer (CFO), and Director, Office of Financial Management (OFM), Centers for Medicare & Medicaid Services, Washington, DC

Don May
Vice President for Policy, American Hospital Association, Washington, DC

Adriana van der Graaf, MBA, RHIA, CCS, CHP, FCS
Revenue Cycle Administrator, Community Memorial Hospital of San Buenaventura, Ventura, CA

John Iglehart
Founding Editor, Health Affairs, National Correspondent, New England Journal of Medicine, Washington, DC (Moderator)

RAC AUDITS THE NUMBER 1 OF TOP TEN COMPLIANCE CHALLENGES FOR HOSPITALS

Click here to see What Are the Top 10 Compliance Challenges for Hospitals?


PHYSICIANS AND HOSPITALS UNPREPARED FOR CMS RAC AUDITS

"Coding experts say doctors and hospitals that don't prepare now for the upcoming federal crackdown on Medicare billing could face six-figure bills, referrals to fraud enforcers, and possible jail time." Encouraged "by the success of its pilot Recovery Audit Contractors, which recovered some $304 million in 2006, the Centers for Medicare and Medicaid Services (CMS) will go nationwide to find errant Medicare billing as early as this fall." But, some providers who have been fined as much as $1.2 million after being audited are fighting back. Michael Miscoe, "a certified professional coder" who "provides coding advice to attorneys defending providers," stated that "the cases have been rising exponentially over the past 10 years." He also predicted that "CMS will 'have a field day' when the crackdown begins." Nevertheless, Miscoe noted, "Compliance is way cheaper than the post-payment gunfight."


CMS POISED TO RELEASE FINAL REPORT ON RAC DEMONSTRATION

The Centers for Medicare & Medicaid Services in the next few weeks will release a final report on the overall outcome of the Medicare recovery audit contractor demonstration, CMS officials told the AHA recently. Following the report, the agency plans to announce the permanent RACs for the nationwide rollout. According to CMS, the permanent RACs will conduct outreach and education efforts prior to starting claims audits. Congress in 2006 made the program permanent and required CMS to operate RACs in all 50 states by 2010. RACs review old Medicare claims, and receive a percentage of the improper payments they identify - both overpayments and underpayments. AHA vice president for policy Don May said, "While the changes CMS has made to improve the RAC program based on the demonstration are good, much more needs to be done to ensure that these programs operate properly and fairly." For information on how to prepare for the RAC program and the legislative campaign to slow down the national rollout, visit www.aha.org.



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