By Ernie Stewart, RTR, CRA, MBA, MHSA
September 2009 — For some time now, healthcare providers have been fighting an uphill battle when it comes to reimbursement. Now the battle is getting even harder. Not only are reimbursement rates decreasing and payments for services provided being rejected, but Centers for Medicare & Medicaid Services (CMS) has a whole new process which could have a potentially negative impact on the bottom line unless you are prepared for a Recovery Audit Contractors (RAC) attack.
The RAC program employs independent contractors across the nation to identify any potential improper payments and reclaim the erroneous payments in exchange for a percentage of the dollars recovered. Experts predict reimbursement investigations will be pursued with a tenacity not previously seen in the healthcare industry, so how can you protect your organization? In this upcoming webinar, the speaker will present strategies to guard against audits and share tips on how to get through one. The webinar will show you how to stay on top of RAC findings, OIG and CERT action plans, as well as how to perfect the art of Medicare claims submission. Because RACs allow for the immediate return of funds to CMS, and the subsequent burden of proof on healthcare institutions to appeal, the best protection to avoid becoming a target of RACs is early prevention. Consistent adherence to nationally accepted best practices and smart internal auditing, which the presenter will detail, will help shield your organization. The session will examine how to review your own results, identify trends, and resolve them before a RAC comes calling. The session will also guide attendees through the necessary steps to take if that RAC call comes. You’ll get a preview of what your organization will receive in the mail, how to handle repayment requests, how to appeal a RAC determination, and how to handle extrapolation repayment requests.
Our presenter for this webinar is Sarah F. Mountford, of Physician’s Business Network, located in Overland Park, KS. Mountford has many years of experience in the field of billing and reimbursement. She has worked with a variety of specialty services and physician practices to analyze financial practices, improve the quality and efficiency of the billing operations, perform coding audits, educate physicians, and document guidelines for coding changes.
In this webinar you will learn to:
- Understand the details of RACs and how they fit into the CMS/MAC system.
- Respond promptly and effectively to a RAC audit/repayment request.
- Prevent future RAC interventions into your organization.
I hope you will join us for this timely and informative presentation. I am sure you will come away with the tools and knowledge to help prevent a RAC attack at your facility.
Ernie Stewart, RTR, CRA, MBA, MHSA, is a director on the 2009-2010 AHRA Board of Directors, as well as Chair of the 2009-2010 Webinar Design Team. He is director, radiology/imaging services at Baylor Health Care System in Garland, TX. He can be reached at email@example.com.