Foley Partner Lawrence Vernaglia spoke with Diane Cahalan, Director, PricewaterhouseCoopers on an audio conference titled Strategies to Prevent and Successfully Appeal RAC Payment Denials for AIS Health on November 18, 2008.
CMS formally launched the national version of the Recovery Audit Contractor (RAC) program Oct. 6, when it announced the four companies that won contingency-fee contracts for identifying Medicare payment errors. When the RACs begin their audits, hospitals will face medical-record requests and overpayment determinations by the hundreds. The damages could be staggering, given the fact that during the three-year pilot, the RACs identified more than $1 billion in improper Medicare payments in just a handful of states. But many hospitals and health systems have saved a fortune by successfully appealing unjustified overpayment determinations. Learn what your organization should do to prepare for RAC audits and, most importantly, which strategies have been used with terrific success to reverse unfavorable outcomes and to prevent future risk exposure.
As contingency-fee contractors, RACs only get paid when they identify payment errors. This compensation incentive has led to fears that RACs will be overzealous in finding billing errors — and some hospitals that have already been involved with RACs now claim that these fears are well-founded. While there have been some adjustments made to the way in which RACs will be compensated and held accountable in the permanent program, expect them to still be diligent in identifying as many payment errors as possible.
Hear from two industry leaders with vast experience representing hospitals and health systems during RAC audits and assisting them during appeals. You will learn:
- How to prepare for a RAC audit and identify potential risk areas in your organization.
- Which risk areas RACs are expected to target nationwide.
- The details of best-practice strategies you should use to appeal RAC overpayment determinations.
- Updates on the latest changes to laws related to Medicare overpayments.
- How to protect your organization and reduce your risk exposure moving forward through establishing consistent operational processes to ensure ongoing compliance with CMS regulations
