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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)


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

Thomas E. Herrmann, JD
Vice President, Strategic Management Services, LLC, Former Administrative Appeals Judge, Medicare Appeals Council (MAC), U.S. Department of Health and Human Services, Alexandria, VA

Lisa Krumpter, RN, MS
Appeals Manager RAC Liaison, Good Samaritan Hospital Medical Center, West Islip, NY

Andrew B. Wachler, Esq.
Principal, Wachler & Associates, PC, Author, "Recovery Audit Contractors and Medicare Audits: Successful Strategies for Preparing for and Defending Audits", Journal of Health Care Compliance, Royal Oak, MI

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


Can You Achieve an 88% Success Rate on RAC Appeals? Learn Proven Hospital Strategies for Successfully Appealing RAC Denials

The RAC program is underway again, and hospitals will continue to be the major focus of attention. There is no way to prevent RAC denials, but hospitals can minimize the impact of recoupments by knowing what, when, and how to appeal. In this national audioconference, four of the most highly rated faculty members from the National Medicare RAC Summit join one of the most successful hospitals in terms of appeal success rates (an 88% win rate on medical necessity appeals) to show you how to develop and implement an effective appeal strategy for your hospital.

The Audioconference agenda is set forth in Eastern Daylight Time below:
1:00 pm Welcome and Introductions
Stewart Presser, Moderator
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
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
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
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
2:05 pm Panel Questions and Answers
Stewart Presser, Moderator
2:30 pm Audioconference Adjournment




A Hybrid Conference, Internet Event and Training Tool
The Leading Forum on the Medicare Recovery Audit Contractor (RAC) Program
Media Partner: Harvard Health Policy Review
September 14 - 15, 2009
Wardman Park Hotel
Washington, DC

RAC Summit Training Program, which includes preconference readings and online courses, the conference video with synchronized PowerPoint presentations and the post conference online exam. This content is perfect for corporate compliance training programs and can be purchased at deep group discounts. Click here for more information.

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