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AGENDA

National Healthcare Compliance Audioconference: RAC Audit Appeals - Strategies and Defenses for Overturning Hospital RAC Denials

  • Tuesday, May 5 , 2009
    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)


The Audioconference agenda is set forth in Eastern Daylight Time below:
1:00 pm Welcome and Introductions
Stewart Presser, Moderator

Presentation Materials in Powerpoint or Acrobat
1:05 pm Dealing with RAC Denials: Determining Whether to Appeal
Kathleen Drummy
  • Assessment of probability of success
  • Cost-Benefit Analysis
    • Risk of future denials
    • Compliance issues
    • Appeal Costs
  • Availability of Physician and other professional support
  • Employment of the non-appeal processes
    • The RAC Rebuttal Process
    • Self-Disclosure and Voluntary Refunds
    • Other Corrective Actions
Presentation Materials in Powerpoint or Acrobat
1:20 pm Overview of the Appeals Process
Andrew Wachler
  • Demand Letter
  • 15-day rebuttal process with RAC
  • Denials sent to Medicare administrative contractor (MAC), fiscal intermediary (FI), or carrier for adjustment
  • Five levels of appeal
    • First level: MAC, FI or carrier internal appeal
    • Second level: Qualified Independent Contractor (QIC)
    • Third level: Administrative Law Judge
    • Fourth level: Medicare Appeals Counsel
    • Fifth level: U.S. District Court
Presentation Materials in Powerpoint or Acrobat
1:35 pm Overturning RAC Denials on Appeal: the ALJ and MAC Perspectives
Thomas Herrmann
  • ALJ and MAC levels of review
  • the legal and evidentiary bases to support a successful appeal
  • whether to request an "in person" hearing, or agree to a video-teleconference (VTC) or telephone hearing
  • pleading with specificity the basis for the appeal
  • legal arguments to be advocated
  • evidence and testimony to submit into the record
  • reviewing the evidence in the record prior to the issuance of a decision
Presentation Materials in Acrobat
1:50 pm How One Hospital Achieved a High Success Rate on Appeals
Lisa Krumpter
  • How we decided what to appeal
  • How we built and managed our appeals team
  • How we won our cases on appeal
Presentation Materials in Powerpoint or Acrobat
2:05 pm Panel Questions and Answers
Stewart Presser, Moderator
2:30 pm Audioconference Adjournment




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