MEDICARE RAC Certificate Program

Reclaiming the funds associated with improper payments is a critical component of the proper stewardship and protection of taxpayer dollars, and it underscores that waste, fraud, and abuse by entities receiving Federal payments will not be tolerated. ... One approach that has worked effectively is using professional and specialized auditors on a contingency basis, with their compensation tied to the identification of misspent funds. Therefore, I hereby direct executive departments and agencies to expand their use of Payment Recapture Audits, to the extent permitted by law and where cost-effective.

President Barack Obama, Presidential Memorandum regarding Finding and Recapturing Improper Payments, March 10, 2010.

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. Additional changes are needed, however, and the results of the GAO study of RAC implementation, previewed by Kathleen King at the very first Medicare RAC Summit, will be presented at this meeting.

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 or rooting out waste, fraud, and abuse, as evidenced by the Marc 10 Presidential memorandum. RAC has been expanded from Parts A and B to Part C and Part D as well. A new program of contingency auditing in the Medicaid program will be established.

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 is pleased to have that new Deputy Administrator, Peter Budetti, open the main Summit with a keynote address.

The Summit continues to offer an online participation option, a very practical and more advanced preconference RAC "Boot Camp" for those newer to the program or wishing to refresh their knowledge, and the 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 technical and tactical 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