VHA's Multi-regional Education Series: Recovery Audit Contractor (RAC) program

The Recovery Audit Contractor (RAC) program is expanding nation wide. The use of CMS contingency fee contractors has resulted in aggressive claims review activity requiring organizations to expend significant resources defending thier coding, admission and billing practices. Understanding how the RAC program works, what areas will likely come under scrutiny and what your organization can do to prepare is essential in successfully dealing with this initiative.

VHA is offering a RAC webinar series designed to assist members in preparing for this program. Industry experts and member experiences will be combined to provide members an outstanding learning and RAC preparation opportunity. From your CEO, CMO and CFO to your key departments impacted by the RAC (Case Management, HIM, Revenue Cycle, Patient Financial Services, Compliance), each session will provide tangible and practical advice and guidance to assist members in preparing for the RACs. Brief descriptions of the first 5 sessions are identified below:

Session 1 – Sept. 4, 2008
What the Chief Executive needs to know to ensure your organization is RAC ready
Speaker: Robert R. Corrato, MD, MBA, President & CEO, Executive Health Resources, Inc.

• Connecting the dots between RAC/MS DRGs/POA
• What senior management should be directing their staff to do
• What processes/structures need to be in place
•  What issues are the source of exposure under the RAC program
•  What strategies are available to mitigate exposure
•  Importance of Medical Staff involvement and strategies to engage

Session 2 – Sept. 26, 2008
RAC Operational Check List – The operational impact of the RAC and how to prepare
Speaker: Robert R. Corrato, MD, MBA, President & CEO, Executive Health Resources, Inc.

• How to assess your current risk
• Key steps needed for success
• Roles & Responsibilities of critical departments
• Preparing for potential barriers
• What to focus on first

Session 3 – Oct. 24, 2008
RAC Case Studies from VHA Members in California, Florida and New York

• Learn first hand from members that have experienced the RAC program
• What is the focus of the RAC audits
• What has been the financial and operational impacts
• What steps have been taken to address
• How is RAC activity being tracked
• What departments are involved and responsibilities

Session 4 - Nov. 10, 2008
The Importance of the Admission Process
Speaker: Kathy Bower, Center for Case Management

• Much of the RAC activity has focused on medical necessity, learn how addressing this front end process will mitigate RAC exposure
• How to Engage Physicians in the Process
• Understand the Impact of Medicare Admission Status Certification Upon the Medical Staff
• Understand the Basics of Regulatory and Clinical Definitions of “Inpatient vs. Observation Status
• Understand the Utility and Limitations of Medical Necessity Screening Criteria
• Rewards for increasing POA, but keep focus on how

Session 5 - Dec. 10, 2008
The RAC Appeals Process
Speaker: Robert R. Corrato, MD, MBA, President & CEO, Executive Health Resources, Inc.

• The flurry of RAC denials has forced providers to become experts at claims denial and appeals management, learn how to succeed
• Understand the RAC Rebuttal, the Legislated Medicare Appeals Process, and Recoupment
• Learn about the different levels of appeal and what is needed at each level
• Practical advice for improving appeals success rates
• Review and Administrative Law Judge (3rd Level) appeal

For webinar registration information, contact your local VHA office for more details.