The Medicare RAC program is now rolling out nationwide and healthcare providers will soon receive their first record requests, if they haven’t already.  In addition to the new commission-based approach to claims audits, the appeals process is very complex and missing a deadline, by as little as one day, can result in the automatic recoupment of your Medicare payments.

Healthcare providers will need to become experts on conducting “Validation Reviews” to know with confidence, when to appeal and ensure that critical deadlines are met, with complete, substantiated information. 

This free webinar will focus on practical measures that you can use immediately to manage the RAC audit appeals process.  The presentation will focus on:

• The current RAC claims review and appeal process with emphasis on critical deadlines and data requirements.  Each step in the process will be addressed:
  • Receipt of the ‘intent letter’,
  • Validation audits,
  • Identification and assessment of risks,
  • Tracking and trending ongoing process, and
  • All 5 levels of appeal.
• Assessment of resources and risk based on the appeal / no appeal decision.
• Key operational steps you can utilize to help ensure successful appeals.
• Aligning resources and establishing accountability across multiple departments.
• Advance preparation (the best defense is a good offense).  Operational approaches for conducting your own internal risk assessments.
• Quantification of the financial impact on individual departments, enabling you to focus on the most potentially costly claims.  The RAC auditors are looking for the most profitable claims – you need to also.
• Review of Transmittal 141, CR 6183 published on 9-12-08;  “Limitation on recoupment/935”.  Be sure to have the transmittal in hand during your participation in the Webinar.  Click Here to download the Transmittal from CMS.

Who Should Attend:

About the Presenter:

Day Egusquiza brings over 28 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. Additionally, her experience includes eight years as a Director of a Physician Medical Management billing service and most recently completed an integrated business office between a hospital and a large physician clinic. She has been an entrepreneur in hospital and physician practice accounts receivable management and a leader in redesigning numerous organizations. Her work includes providing guidance as a compliance and APC educator while providing operational insight on the revenue cycle impacts of HIPAA.  Additionally, she has been instrumental in researching and preparing national education on the impact of the Prescription Drug Benefit to hospitals and nursing homes. Ms. Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance- both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, HFMA faculty, CCH Reimbursement Advisory board and is a past President of the Idaho HFMA Chapter &; recently received the Lifetime Achievement Award. She has been highlighted in JCAHO's Six Hospitals in Search of Excellence, Zimmerman's Receivable Report, HFMA's HFM and Patient Account, AHIA Prospective, and numerous healthcare newsletters along with a contributing author to 2006 Health Law and Compliance Update. She received the Idaho Hospital Association Distinguished Service Award; for her legislative work and training on new indigent law. Attendees at HFMA's ANI rated her in the top 25%, earning her the 'Distinguished' Speaker recognition for each year she has presented.