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National Healthcare Compliance Audioconference:
Update on CMS Rollout of National Recovery Audit Contractors "RAC" Program

Wednesday, October 22, 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)


Lori Dempsey
Director of Corporate Compliance and Ethics, Mount Sinai Medical Center, New York, NY

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

Stewart M. Presser
Vice President, Greater New York Hospital Association, New York, NY

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


The CMS has begun the initial phase-in of its Recovery Audit Contractor program by announcing the four new contractors that will administer the program. Each RAC will be responsible for identifying overpayment and underpayments in approximately one-quarter of the country, according to the agency.

The contractors are: Diversified Collection Services, Livermore, Calif., which will initially cover the states of Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont; CGI Technologies and Solutions, Fairfax, Va., which will cover Indiana, Michigan and Minnesota; Connolly Consulting Associates, Wilton, Conn., which will cover Colorado, Florida, New Mexico and South Carolina; and HealthDataInsights, Las Vegas, which will cover Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming.

Additional states will be added to each RAC region in 2009, according to the CMS. The RAC program, initially pilot-tested in several states, was created to identify and correct improper Medicare payments paid to healthcare providers in fee-for-service Medicare. In July, the CMS reported the demonstration project recovered $1 billion in improper payments made since 2005.

HHS is required to make it a permanent, national program in all 50 states by Jan. 1, 2010.


"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."

The Audioconference agenda is set forth in Eastern Daylight Time below:

1:00 pm Welcome and Introductory Comments
John Iglehart
1:05 pm Update on National Rollout of the CMS Recovery Audit Contractors "RAC" Program
Timothy B. Hill, MPA
1:25 pm The New York State 3 Year RAC Demonstration Experience
Stewart M. Presser
1:40 pm How to Position and Prepare Your Organization for a RAC Audit
Lori Dempsey
1:55 pm RAC Legal Developments and Strategies for Successful Appeals
Kathleen Houston Drummy, Esq.
2:10 pm Panel Questions and Answers
John Iglehart (Moderator)
2:30 pm Audioconference Adjournment


A Hybrid Conference, Internet Event and Training Tool
Sponsored by Harvard Health Policy Review
March 5 - 6, 2009
Renaissance Washington DC Hotel
Washington, DC


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