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National Medicare RAC Summit

Published on: Mar 3, 2016
Source: www.slideshare.net


Transcripts - National Medicare RAC Summit

  • 1. www.RACSummit.com The SEVENTH NATIONAL Medicare RAC (and MAC) A Hybrid Conference, Internet Event & Training Tool Summit 7II TEKI Getting it Right the First Time . . . and What to Do if You Don’t December 4 – 6, 2012 Mandarin Oriental Washington, DCCONFERENCE CO CHAIRS: SILVERErnie de los Santos, Founder and Principal, The RAC Shadow and GR ANTORS:Appeal Academy (Postconference)Day Egusquiza, President, AR Systems, Inc. (Preconference)Linda Fotheringill, Co-Founder and Partner, Washington & West, LLCLarry T. Hegland, MD, Chief Medical Officer, Ministry Saint Clare’s Hospital,The Diagnostic and Treatment CenterRyan Meade, Partner, Meade & RoachKEYNOTE SPEAKERS:Rochelle Archuleta, Senior Associate Director for Policy, American HospitalAssociation BRONZE GR ANTORS:The Honorable Michael D. Bartko, U.S. Administrative Law JudgePeter B. Budetti, MD, JD (Invited), Deputy Administrator and Director,Center for Program Integrity, Centers for Medicare and Medicaid ServicesAmy (King) Caro, Vice President, Health IT Programs, Northrop GrummanInformation SystemsDeanna Cruser, Provider Outreach and Education Senior Analyst,CGS Administrators, LLCTara Mondock, Vice President, Healthcare, Ivans, Inc.ISSUES TO BE ADDRESSED:ˆ LERKIW MR 17 4VSKVEQ -RXIKVMX] 4VSKVEQˆ 8LI %,% 4SPMG] ERH %HZSGEG] %KIRHEˆ 17 4VIHMGXMZI 1SHIPMRK SRXVEGXSV 6SPIW A D D I T I ON A Lˆ 1% 6SPIW ERH 6IPEXMSRWLMTW GR ANTORS:ˆ ;LEX MW ER ±-RTEXMIRX²# ERH ,S[ XS +IX -X 6MKLXˆ 8LI )QIVKIRGI SJ XLI 1IHMGEMH 6%Wˆ )PIGXVSRMG 7YFQMWWMSRW SJ %YHMX (SGYQIRXEXMSR
  • 2. IW1(ˆ 1% ERH 6% 4VITE]QIRX 6IZMI[W M ED I Aˆ 1IHMGEVI %HZERXEKI 4PER (IRMEPW ERH %TTIEP -WWYIW PARTNERS:ˆ ,S[ XS 1EOI XLI (MWGYWWMSR 4IVMSH ;SVO JSV =SYˆ 6ILEF ERH 0SRK 8IVQ EVI -WWYIWˆ 8LI 0IKEP 9THEXI 4ERIPˆ &YMPHMRK ER )JJIGXMZI 96 ERH 4% 8IEQˆ ;LEX %0.W 0SSO *SV ERH ,S[ XS 4VITEVIˆ 6%W ERH SQQIVGMEP ,IEPXL 4PERWˆ YVVIRX SRKVIWWMSREP -WWYIW ERH -RXIVIWXW CO-LOC ATED WITH THE SIXTH NATIONALˆ 4EVX % XS 4EVX 6IFMPPMRK (IQSRWXVEXMSR PREDICTIVE MODELING SUMMITˆ HE] ;MRHS[ XS 6IXYVR ±-HIRXMJMIH² 3ZIVTE]QIRXW www.PredictiveModelingSummit.comˆ ;MRRMRK %TTIEP 7XVEXIKMIW
  • 3. 6% IVXM½GEXI 4VSKVEQWSZIV -PPYWXVEXMSR F] JOHN GUMMERE %7- 6% )68-*-%8) 463+6%1 ADVANCED RAC CERTIFICATE PROGRAM The Seventh National RAC (and MAC) Summit is offering a Basic The Seventh National RAC (and MAC) Summit is also RAC Certificate Program in the form of an optional course within offering an Advanced RAC Certificate Program in the form of an op- the conference for attendees wishing to take a deeper dive into the tional course within the conference for those attendees who already Summit’s subject matter. The Program requirements are: - The Program requirements are: ground information. See website to review the set of pre-course reading materials to review the set of pre-course reading materials. for and responding to RAC audits, prepared by Davis Wright The RAC Shadow and Appeal Academy. Tremaine and Deloitte Touche - tion within 90 days with a score of 70% or better (three attempts requirements will receive a certificate of completion. requirements will receive a certificate of completion. This certificate is evidence that This certificate is evidence that has successfully completed the has successfully completed the Basic RAC Advanced RAC Certificate Program Certificate Program Offered at the Seventh National Offered at the Seventh National RAC (and MAC) Summit RAC (and MAC) Summit December 4 – 6, 2012 December 4 – 6, 2012 in Washington, DC in Washington, DC AN EXAMPLE OF A CORPORATE RAC CERTIFICATE PROGRAM Group Discount Allows Multiple Staff to Pursue 6% IVXM½GEXIW 2
  • 4. THE SEVENTH NATIONAL RAC (AND MAC) SUMMIT ne of the most significant changes in theO Medicare program recently has been theintroduction of “recovery audit contracting” THE R AC CERTIFICATE PROGR AMS Overview(RAC) as a way of assuring that proper pay- The National RAC Summit series has always offered a RAC Certificate Program in the form of an op-ments are being made for Medicare services. tional course within the conference for attendees wishing to take a deeper dive into the Summit’s sub-In the new RAC model, contractors are ject matter. In 2012 the Summit is pleased to offer an Advanced program as well as a Basic program.incentivized with contingency fees to find 8LI 6 % IV XM½GEXI 4VSKVEQW´ GYVVMGYPYQ ERH VIUYMVIQIRXWimproper overpayments (and underpayments) are as follows:to providers of Medicare services. New RACcontractors are now being put into place bythe States for the Medicaid program, height- Deloitte Touche; and for the Advanced program, prepared by The RAC Shadow and Appealening the potential for provider burden and Academy (3 hours).contractor overlap, including overlap withState OIG initiatives and other entities target-ing outright fraud.Provider complaints about overzealous RAC ;LS 7LSYPH %XXIRH#contractors have now reached Congress, ashave complaints about inefficient MICs in Medicare MAC and RAC environment, together with issues arising from implementation of the newthe Medicaid program and aggressive ZPICs -targeting fraud in hot spots. As a result, CMS cian practices as well, particularly in areas of joint risk. Hospital RAC liaisons, clinicians, complianceis in the process of making changes to the officers, CFOs, medical coding and billing staff, patient accounts managers, and other financial andoverall program integrity effort, with new auditing personnel are prime candidates for the certificate programs. Group discounts encourage participation by an entire RAC team.December. The most dramatic new wrinkle 0IEVRMRK 3FNIGXMZIWin 2012 is the decision by CMS to allow the The purpose of the RAC Certificate Programs is to give participants the understanding and toolsMACs to conduct prepayment review of ques- necessary to work successfully with the new Medicare MAC and RAC processes, requirements, andtionable claims for medical necessity, site of timetable, as well as issues with Medicaid audits and Medicaid RACs. By the end of this training, par-service, and improper coding, preventing pay- ticipants will be able to create an action plan that will outline key initiatives to be taken with respect toment on the front end. The same authority is MAC and RAC implementation and tracking in their own organizations.now available to the RACs as of August 2012. Program DescriptionAnd beyond the Medicare FFS program, This is a practical, in-depth program for professionals who want to understand MAC and RAC issuesMedicare Advantage plans are now conduct-ing audits and denying claims, and even some training, while the Advanced program caters to those who have increasing levels of knowledge andcommercial health plans have contracted with training in the field. At the end of the program, participants will have 90 days to complete the respec-the RACs to look for patterns of overpaymentor even fraud. Program Completion Those who successfully complete the program requirements (see the five bulleted requirements above),Now in its seventh iteration, the National including preconference readings and an online post conference test with a score of seventy percentRAC (and MAC) Summit brings together (70%) or more, will receive a certificate of completion of the Medicare RAC Certificate Program.seasoned hospital representatives, best of breedsolutions companies, and savvy compliance *VIUYIRXP] %WOIH 5YIWXMSRW -W XLI 6% IVXM½GEXI 4VSK VEQ E TVSJIWWMSREP GIVXM½GEXMSR TVSK VEQ# It is not.provide very practical advice for how to get it The program constitutes an attempt to organize a focused curriculum around implementation strate-right the first time … and what to do if you gies and issues pertaining to recovery audts, while giving evidence of successful completion of thatdon’t. The Summit continues to offer onsite body of knowledge through the issuance of a certificate of completion.and online participation, and has now added 4PIEWI HIWGVMFI XLI TSWXQIIXMRK SRPMRI IEQMREXMSR The post-meeting onlinean Advanced as well as a Basic RAC CertificateProgram. This year’s Preconference draws on preconference readings, online courses, preconferences, and the Summit itself. Candidates may takebest practices from hospitals around the coun-try to teach attendees how to create a strongUtilization Review function that works inconcert with a strong Physician Advisor func- complete this requirement successfully.tion, no matter the hospital size. The agenda ,EW ER] SXLIV GSRJIVIRGI SJJIVIH E GSQTEVEFPI GIVXM½GEXI TVSK VEQ# Yes, the Quality Colloquium at Harvard University, www.QualityColloquium.com, has offered a Patientinteraction and provide practical “how to” Safety Certificate Program for the past four years. Similar training programs have been offered in con-advice on both Medicare and Medicaid issues, nection with the National Medical Home Summit, the National Disclosure Summit, the Populationand on MAC as well as RAC issues. More than Health and Care Coordination Colloquium, and the National Medicare Readmissions Summit.ever before, it is a “must” event. 3
  • 5. Tuesday, December 4, 2012 Wednesday, December 5, 2012 TQ 6IKMWXVEXMSR 3TIRW (%= - 7911-8 %+)2(% ° 34)2-2+ 40)2%6= 7)77-32 ° 2%8-32%0 -779)7 %2( 2%8-32%0PRECONFERENCE: GETTING IT RIGHT THE FIRST 40%=)678-1) ° 9-0(-2+ % 78632+ 98-0-%8-326):-); %2( 4,=7--%2 %(:-736 4%682)67,-4 EQ 6IKMWXVEXMSR 3TIRW(Registration optional but required for RAC Certificate Programs) 8:00 am Welcome and Overview Ryan Meade, Partner, Meade Roach, Chicago, IL (Co Chair) TQ ;IPGSQI ERH 3ZIVZMI[ SJ XLI -WWYIWDay Egusquiza, President, AR Systems, Inc., Twin Falls, ID (Chair) 8:15 am Changes in Management of CMS Program Integrity Contractors TQ 8LI -QTSVXERGI SJ SRGYVVIRX 6IZMI[ Peter B. Budetti, MD, JD (Invited), Deputy Administrator and ° JSV FSXL )( ERH 7GLIHYPIH)PIGXMZI Director, Center for Program Integrity, Centers for Medicare and Surgery Admissions Medicaid Services, Baltimore, MD ˆ *MVWX 0IZIP ° 1MPPMQER-RXIV5YEP VMXIVME ˆ 7IGSRH 0IZIP ° 4L]WMGMER 6IZMI[ 9:00 am Use of Predictive Modeling to Detect 3ZIVTE]QIRXW%FYWI ˆ % 0SSO EX 7IPIGXMZI EWIW Amy (King) Caro, Vice President, Health IT Programs, Northrop ˆ %YHMIRGI *IIHFEGO ERH 5% Grumman Information Systems, McLean, VA.IJJVI] ) )TWXIMR 1( Medical Director, Continuum of CareDepartment, Morristown Medical Center, Atlantic Health System, EQ 1% 6SPIW ERH 6IPEXMSRWLMTWMorristown, NJ Deanna Cruser, Provider Outreach and Education Senior Analyst,Lori Horrall, RN, BSN, MSM, Manager, Utilization Management, CGS Administrators, LLC, Nashville, TNUnion Hospital, Terre Haute, IN 10:00 am Networking Break TQ YMPHMRK E 7XVSRK 96 4VSGIWW 10:30 am What ALJs Look For ˆ )QTS[IVMRK XLI 96 *YRGXMSR7XEJJ The Honorable Michael D. Bartko, U.S. Administrative Law ˆ 8LI SQTPMERGI 63- JVSQ 7XVSRK 96 Judge, Cleveland, OH ˆ 8LI *MRERGMEP 63- JVSQ 7XVSRK 96Day Egusquiza, President, AR Systems, Inc., Twin Falls, ID 11:15 am Moving to Full Electronic SQQYRMGEXMSR ° ER IW1( 9THEXILori Horrall, RN, BSN, MSM, Manager, Utilization Management, Tara Mondock, Vice President, Healthcare, Ivans, Inc., Stamford, CTUnion Hospital, Terre Haute, IN TQ 2IX[SVOMRK 0YRGL ° TQ VIEO 3TXMSREP 8EFPI 8STMGW TQ IWX 4VEGXMGIW JVSQ XLI *MIPH ° Different Models for the Physician %HZMWSV *YRGXMSR ° 4EVX8MQI (%= - 7911-8 %+)2(% ° %*8)62332 *YPP8MQI 3YXWSYVGI ,]FVMH 40)2%6= 7)77-32 ° ,38 -779)7E. G. “Nick” Ulmer, Jr., MD, CPC, Vice President, ClinicalServices and Medical Director for Case Management, Spartanburg TQ ;IPGSQI ERH 3ZIVZMI[Regional Health System, Spartanburg, SC Larry T. Hegland, MD, Chief Medical Officer, Ministry Saint Clare’s Hospital, The Diagnostic and Treatment Center, Weston, WI TQ *EGYPX] 5% ERH %YHMIRGI *IIHFEGO (Co Chair) 6IKEVHMRK 2IX 7XITW TQ ,SX -WWYIW - ° 1% ERH 6% TQ 4VIGSRJIVIRGI %HNSYVRQIRX 4VITE]QIRX 6IZMI[W Stewart Presser (DCS and NGS), Greater NY Hospital Association, New York, NY Hotel Information/Reser vations /EXL] 6IIT
  • 6. *73 ERH SRRSPP] Florida Hospital Association, Orlando, FL 7KH 0DQGDULQ 2ULHQWDO :DVKLQJWRQ LV WKH RIÀFLDO KRWHO IRU WKH 6HYHQWK 1DWLRQDO 0HGLFDUH 5$ 6XPPLW $ VSHFLDO JURXS UDWH RI SOXV WD[
  • 7. SHU Larry T. Hegland, MD (CGI and NGS), Chief Medical Officer, GHOX[H URRP KDV EHHQ DUUDQJHG IRU 6XPPLW $WWHQGHHV 7R ERRN RXU UHVHUYDWLRQ Ministry Saint Clare’s Hospital, The Diagnostic and Treatment RQOLQH DQG DFFHVV WKH JURXS UDWH JR WR ZZZUDFVXPPLWFRPWUDYHOKWPO Center, Weston, WI )RU WHOHSKRQH UHVHUYDWLRQV FDOO WROO IUHH DW RU RQSURSHUW DW :KHQ FDOOLQJ LQ DVN IRU ´0(,$5( 5$ 6800,7µ WR UHFHLYH 1MOI *VMXL
  • 8. ,(- ERH 4EPQIXXS2SVMHMER;47 Regional WKH JURXS UDWH 5HVHUYDWLRQV DW WKH JURXS UDWH ZLOO EH DFFHSWHG ZKLOH URRPV DUH Manager, Patient Accounts, Trinity Health-Saint Alphonsus, Boise, ID DYDLODEOH RU XQWLO WKH FXWRII GDWH RI Tuesday, November 13, 2012 $IWHU WKLV Brian Annulis, Partner, Meade Roach, Chicago, IL (Moderator) UHVHUYDWLRQV ZLOO EH DFFHSWHG RQ D VSDFHDYDLODEOH EDVLV DW WKH SUHYDLOLQJ UDWH Mandarin Oriental, Washington DC 0DUODQG $YHQXH 6: ‡ :DVKLQJWRQ 4
  • 9. TQ ,SX -WWYIW -- ° 1IHMGEVI %HZERXEKI EQ 0IKEP 9THEXI (IRMEPW ERH %TTIEP -WWYIW Ryan Meade, Partner, Meade Roach, Chicago, ILShannon Pavel, RN, CPHM, Clinical Appeals and Denials Linda Fotheringill, Co-Founder and Partner, Washington West,Coordinator, Infirmary Health, Mobile, AL LLC, Baltimore, MD TQ ,SX -WWYIW --- ° 6ILEF ERH Amy F. Lerman, Associate, Epstein Becker Green, Washington, DC Long Term CareJane Snecinski, President, Post Acute Advisors, Atlanta, GA 11:15 am Current Congressional Interests and Initiatives TQ 2IX[SVOMRK VIEO Matt Kazan, MPP (Invited), Health Policy Advisor, Senate Finance Committee Majority Staff, Washington, DC TQ ,SX -WWYIW -: ° ;LEX MW ER ±-RTEXMIRX² Kimberly Brandt, CHC, JD (Invited), Chief Healthcare Investigative ... and How to Get It Right Counsel, Senate Finance Committee Minority Staff; Former Counsel,Day Egusquiza, President, AR Systems, Inc., Twin Falls, ID Allston Bird LLP; Former Director, Medicare Program Integrity Group, Centers for Medicare and Medicaid Services, Washington, DC TQ ,SX -WWYIW : ° 8LI 2EXMSREP 4EVX % to Part B Billing Demonstration TQ 7YQQMX %HNSYVRQIRXMike Frith, Regional Manager, Patient Accounts, Trinity Health-Saint Alphonsus, Boise, ID TQ 0YRGL JSV 4SWXGSRJIVIRGI 4EVXMGMTERXW TQ ,SX -WWYIW :- ° )QIVKIRGI SJ 437832*)6)2) 2S *IEV %TTIEP 7XVEXIKMIW ° Medicaid RACs Sponsored by Appeal AcademyMarkus Cicka, Director, Missouri Medicaid Audit and Compliance,State of Missouri, Jefferson City, MO TQ ;IPGSQI ERH -RXVSHYGXMSRW/EXL] 0MTTQERR Vice President, State Government Services Ernie de los Santos, Founder and Principal, The RAC Shadow andMid-Atlantic, HMS, Richmond, VA Appeal Academy, Los Angeles, CA (Postconference Chair)7XIZIR % +VIIRWTER .( 001 Vice President of RegulatoryAffairs, Executive Health Resources, Newtown Square, PA TQ ,S[ XS 1EOI XLI (MWGYWWMSR 4IVMSH ;SVO JSV =SY©;,3 MW 1SVI -QTSVXERX TQ (E] - %HNSYVRQIRX ERH 2IX[SVOMRK than WHAT 6IGITXMSR MR XLI )LMFMX ,EPP Sharon Easterling, MHA, RHIA, CCS, CDIP, President and Chief Executive Officer, Recovery Analytics, Charlotte, NC TQ 8LI %0. ,IEVMRK ° %REXSQ] SJThursday, December 6, 2012 %TTIEPW XLEX ;SR ERH 0SWX ERH ;L] 7XIZIR % +VIIRWTER .( 001 Vice President of Regulatory(%= -- 7911-8 %+)2(% ° 8,) 63%( %,)%( Affairs, Executive Health Resources, Newtown Square, PA EQ 6IKMWXVEXMSR 3TIRW TQ %TTIEP 0IXXIVW XLEX ;-2 ° -RGPYHMRK 7EQTPI 8IQTPEXIW 2IX[SVOMRK VIEOJEWX MR XLI )LMFMX ,EPP Denise Wilson, Director, Audit and Appeals Services, Intersect 3TXMSREP ,SWXIH 8EFPI 8STMGW Healthcare, Inc., Lutherville, MD8:00 am Welcome and Overview TQ 6IGIRX ;MRRMRK 7XVEXIKMIW ERH 8EGXMGWLinda Fotheringill, Co-Founder and Partner, Washington West, — What to Do Now, What’s Changed,LLC, Baltimore, MD (Co Chair) What’s Not Andrew B. Wachler, Esq., Principal, Wachler Associates, PC,8:15 am The Road Ahead — AHA Policy Agenda Royal Oak, MIRochelle Archuleta, Senior Associate Director for Policy,American Hospital Association, Washington, DC TQ *MREP %YHMIRGI 5% [MXL *EGYPX] 4ERIP Ernie de los Santos, Founder and Principal, The RAC Shadow and9:00 am Commercial Health Plans and Appeal Academy, Los Angeles, CA (Moderator) Recovery AuditsElaine N. Foster (Invited), Senior Health Care Analyst, TQ 4SWXGSRJIVIRGI %HNSYVRQIRXUtilization Review, Blue Cross Blue Shield of Michigan, Detroit, MI EQ 8LI 8ST 8LMRKW =SY 2IIH XS /RS[ ERH (S FIJSVI =SYV %0. ,IEVMRK EXHIBIT AND SPONSORSHIP OPPORTUNITIESMichael Salvatore, MD, FACP, Physician Advisor, Beebe Medical 7DNH DGYDQWDJH RI WKLV XQLTXH RSSRUWXQLW WR H[SDQG RXU UHDFK 7KH 6XPPLW LV DWWHQGHG E KLJKO LQÁXHQWLDO DQG H[SHULHQFHG SURIHVVLRQDOV 6SRQVRUVKLSCenter, Lewes, DE RIIHUV RX VWUDWHJLF SRVLWLRQLQJ DV DQ LQGXVWU OHDGHU )RU PRUH LQIRUPDWLRQ FDOO RU HPDLO H[KLELWV#KFFRQIHUHQFHVFRP10:00am Networking Break and Prize Drawing MR XLI )LMFMX ,EPP 5
  • 10. PARTICIPATION Live and Archived Internet AttendanceOPTIONS Watch the conference in live streaming video of plenary sessions and listen to audio of preconferenceTraditional Onsite Attendance and postconference over the Internet and at yourSimply register, travel to the conference city %X ]SYV SJ½GI and attend in person. Onsite the event.PROS: subject matter immersion; professional The archived conference includes speaker video andnetworking opportunities; faculty interaction. audio and coordinated PowerPoint presentations. anywhere worldwide with Internet access; avoid travel . . . or home8,) *3003;-2+ 6)+-786%8-32 8)617 %2( 32(-8-327 %440=REGARDING INTERNET REGISTRATIONS 8% ()(98--0-8= ,QGLYLGXDOV RU JURXSV PD UHJLVWHU IRU ,QWHUQHW DFFHVV 2UJDQL]DWLRQV PD UHJLVWHU ([SHQVHV RI WUDLQLQJ LQFOXGLQJ WXLWLRQ WUDYHO ORGJLQJ DQG PHDOV LQFXUUHG WR PDLQWDLQIRU JURXS DFFHVV ZLWKRXW SUHVHQWLQJ VSHFLÀF UHJLVWUDQW QDPHV ,Q VXFK LQVWDQFHV WKH RU LPSURYH VNLOOV LQ RXU SURIHVVLRQ PD EH WD[ GHGXFWLEOH RQVXOW RXU WD[ DGYLVRUUHJLVWHULQJ RUJDQL]DWLRQ ZLOO EH SUHVHQWHG D VHULHV RI XVHU QDPHV DQG SDVVZRUGV WR )HGHUDO 7D[ , GLVWULEXWH WR SDUWLFLSDQWV CONTINUING EDUCATION UNITS (CEUs) (DFK UHJLVWUDQW ZLOO UHFHLYH D XVHU QDPH DQG SDVVZRUG IRU DFFHVV 5HJLVWUDQWV ZLOO 7KH 6XPPLW LV H[SORULQJ RQWLQXLQJ (GXFDWLRQ UHGLWV (8V
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  • 42. The Seventh NationalRAC (and MAC) SummitPublications Printing Dept.41651 Corporate WayPalm Desert, CA 92260USA(Address for Return Mail Only) A Hybrid Conference,Internet Event Training Tool See page 6www.RACSummit.com www.RACSummit.com The SEVENTH NATIONAL Medicare RAC (and MAC) A Hybrid Conference, Internet Event Summit Training Tool See page 6 Getting it Right the First Time . . . and What to Do if You Don’t December 4 – 6, 2012 Mandarin Oriental Washington, DC CO-LOCATED WITH THE SIXTH NATIONAL PREDICTIVE MODELING SUMMIT • www.PredictiveModelingSummit.com

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