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MEDICARE RAC Certificate Program

One of the most significant changes in the Medicare program recently has been the introduction of "recovery audit contracting" (RAC) as a way of assuring that proper payments are being made for Medicare services. In the new RAC model, contractors are incentivized with contingency fees to find improper overpayments (and underpayments) to providers of Medicare services. (Providers and contractors now both benefit from the identification of underpayments as well, but these represent a very small part of the action.) On October 1, 2008 CMS announced the four contractors who will manage the permanent program in four respective geographic regions, and on February 4, 2009 CMS announced that the parties involved in the protest of those contractor awards had reached a settlement and that national implementation would resume.

CMS made a number of changes based on lessons learned in the demonstration regarding RAC contractor staff expertise, limits on records, customer service and transparency requirements, and oversight. As national implementation proceeds, CMS continues to fine tune the program in an effort to ensure that it is both effective and fair to providers.

But there is a much larger program integrity agenda in play. With the enactment of the Patient Protection and Affordable Care Act (PPACA), there is a renewed sense of vigor and urgency to the process of rooting out waste, fraud, and abuse. RAC has been expanded from Parts A and B to Part C and Part D as well. A new program of contingency auditing in Medicaid will also take effect in 2011. And a recent CMS realignment created a new position of Deputy Administrator for Program Integrity, overseeing both the Medicare Integrity Program and Medicaid Integrity Program.

The Summit continues to offer both onsite and online participation option, plus an option to purchase a flash drive at registration for a reduced rate. An advanced Preconference Boot Camp draws on best practices from hospitals around the country to help participants structure an appropriate, comprehensive approach to managing audit and program integrity activity.

Finally, the Summit again offers the popular Medicare RAC Certificate Program for those who want to take a deeper dive into the subject matter. The agenda is crafted to maximize networking and speaker interaction, provide "how to" advice on organizing and managing a revenue integrity program, and cover both Medicare and Medicaid RAC issues. In a new era of aggressive program integrity activity, it is a "must" event.

  • Provider Corporate Compliance Officers and Staff
  • Coding Professionals
  • Billing and Finance Office Staff
  • Health Information Management Professionals
  • Appeals Management
  • Utilization Review/Utilization Management Staff
  • Nursing and Medical Staff Members
  • Hospital and Nursing Home Admission and Discharge Personnel
  • Corporate Ethics Staff
  • Legal Counsel for Providers and Medicare Suppliers
  • Health System and Hospital Executives and Senior Managers
  • Physician Group Executives and Medical Directors
  • Nursing Home, Home Health Agency, and Hospice staff
  • Laboratory, Durable Medical Equipment, and Ambulance Representatives
  • Federal Agencies, including CMS, HHS OIG, and GAO
  • Congressional Staff
  • Law firms specializing in Medicare regulations and appeals
  • Vendors and Consulting Firms with Products, Services and Solutions to Assist in Preparing for, Responding to, and Appealing RAC Audits

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