Preparing for Medicare s Recovery Audit Contractor (RAC) Permanent Program: Are you ready?

Size: px
Start display at page:

Download "Preparing for Medicare s Recovery Audit Contractor (RAC) Permanent Program: Are you ready?"

Transcription

1 Preparing for Medicare s Recovery Audit Contractor (RAC) Permanent Program: Are you ready?

2 Presentation topics Premier Consulting Solutions (PCS) Background RevenueConnect RAC Overview The Demonstration Project RAC Permanent Program Our Approach to RAC Preparation and Implementation Conclusion Next Steps 1

3 Why Premier Consulting Solutions? Accelerated Performance PCS offers deep expertise and consulting capabilities in the areas of revenue cycle improvement, including RAC readiness and charge capture, strategic planning and service line analysis, which align with transformational consulting and service line solutions offerings. Connect with End-to-End Solutions PCS offers the skills and expertise to assist its alliance members in all areas of performance improvement: enhancing revenue and increasing margins, efficient management of key cost areas of labor and supplies, and improving its quality performance. 2

4 Why Premier Consulting Solutions? Core Benefits include: Access to Premier s Perspective database, the industry s largest clinical, operational and financial data resource including millions of patient records and comparative benchmarks Proven blueprint for Recovery Audit Contractor (RAC) preparedness Expertise in assessing RAC-related risk and managing RAC review and appeals process Long-term productive relationship with Centers for Medicare & Medicaid Services (CMS) with continuous feedback loop Extensive, specialized consulting personnel with an average of 20 years experience in management and clinical expertise Active support from more than 100 subject matter experts Access to tools and resources proven to realize and hold gains Proven, accelerated methodologies with customized design 3

5 RevenueConnect: Harnessing revenue expertise Pressure on revenue has never been greater with ongoing changes in reimbursement from pay-forperformance, value-based purchasing, payment bundling, and payment recovery audits. PCS combines expertise in Medicare RAC preparation and management with extensive experience in clinical process and revenue cycle management, and utilizes collaborative knowledge sharing among our alliance members to provide an unsurpassed triple threat to ensure maximum revenue retention. 4

6 RevenueConnect: Harnessing revenue expertise p Sustaining improvement across your organization requires more than short- term, temporary reactions. High-performing cultures require a framework of standard data tools and proven processes. Premier s Connect programs provide a comprehensive, integrated framework of product and service offerings targeting the needs of healthcare organizations. 5

7 Are you ready for RAC? This is how the RAC program will become part of your reality: Medicare identified as one of the top 3 Federal programs with improper payments totaling $10.8 billion in 2007 alone.* The RAC program was created through the Medicare Modernization Act of 2003 to identify these improper Medicare payments. In March 2005, Congress authorized the RAC Demonstration project for the purpose of identifying underpayments and overpayments and recouping overpayments. As of March 2008, RACs succeeded in correcting more than $1.03 billion in improper Medicare payments. The Tax Relief and Health Care Act of 2006 authorized the expansion of the RAC program to all 50 states by This is what you ll need to do to prepare: Develop an internal audit process to identify risk before the RACs arrive and manage it after they leave. Avoid submitting claims that do not comply with Medicare rules by tracking denied claims. Proactively identify cases that may be at risk in a RAC audit. Manage the appeal process for any cases in which you do not agree with the RAC's determination. Address improper payments by reviewing online reports of those discovered at other hospitals by RAC as well as in Office of Inspector General and Comprehensive Error Rate Testing reports. Define ways to encourage compliance based on over- and underpayment errors found. Create a RAC prevention program. *Source: Office of Management and Budget 6

8 Are you ready for RAC? Have you completed the following steps in order to prepare for your upcoming RAC audits and ongoing RAC management process? 7

9 RAC demonstration findings As of March 2008, the RAC Demonstration Project succeeded in correcting more than $1.03 billion in Medicare improper payments. Approximately 96% ($992.7 million) of the improper payments were overpayments collected from providers. The remaining 4% ($37.8 million) were underpayments repaid to providers. Source: The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-Year Demonstration, July

10 RAC demonstration findings overpayments Overpayments collected by provider type: 85% from inpatient hospital providers 6% from inpatient rehabilitation facilities 5% from skilled nursing facilities, physician or other 4% from outpatient hospital providers Overpayments collected by error type: 40% medically unnecessary 35% incorrectly coded 8% missing or insufficient documentation 17% other Source: The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-Year Demonstration, July

11 RAC demonstration financial impact RACs reported that, on average, about 65% of hospital providers Medicare revenues were not affected by the RAC Demonstration, and 25% of hospital providers only had up to 2.5% revenue impact. The remaining 10% of hospital providers had more than 2.5% revenue impact, meaning the $1.03 billion in improper payments came from only 10% of hospitals. Source: The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-Year Demonstration, July

12 Potential financial impact Based on the assumption that 25% of the Medicare payment amounts were affected at a 2.5% rate: Estimate of financial impact to be calculated here for each respective hospital or health care system. 11

13 Recovery Audit Contractors On October 6, 2008, CMS announced the names of the new national RACs as follows: Region A: Diversified Collection Services, Inc. of Livermore, California. Region B: CGI Technologies and Solutions, Inc. of Fairfax, Virginia. Region C: Connolly Consulting Associates, Inc. of Wilton, Connecticut. Region D: Health Data Insights, Inc. of Las Vegas, Nevada. Additional subcontractors have been added to assist RACs in each of the four regions, including PRG Shultz, ihealth Technologies, Strategic Health Solutions, and Viant, Inc. 12

14 RAC permanent program CMS plans to implement the RAC permanent program gradually and recently confirmed a newly revised timeline: See the following page for original color coded phase-in schedule. 13

15 RAC permanent program 14

16 How hospitals should prepare To minimize the risk of RAC audit, hospitals should take steps now to ensure the highest level of admission and claim accuracy. Many of these steps are not anything new. Typical areas of risk include Medical Necessity screening, Case Management, Denials and Appeals management, and accurate Coding and Documentation. Hospitals may already have some or all of these systems and protocols in place, but may wish to revisit it them with a focus on the patterns of payment recovery that emerged during the RAC demonstrations. 15

17 The Premier approach We recommend the following seven steps to prepare for your upcoming RAC Audits: Form a Multidisciplinary i li RAC Task Force to oversee RAC preparation, management, and ongoing process improvement. Perform a high-level assessment of existing tools and processes (including the use of Premier s proprietary RAC risk assessment tool) to identify current RAC exposure for errors and payment recoveries. Conduct an internal coding and documentation audit to assess current RAC risk for accounts dating back to October 1, 2007, based on key risk areas identified during the RAC Demonstration Project. Develop a formal process to educate staff and physicians about the RAC permanent program, findings from the ongoing audit process, and process changes required to reduce the risk of future denials or payment recoveries. Develop a formal strategy to prepare for and manage the RAC process (notifications, chart requests, staffing requirements, tracking, etc.) and determine whether outside assistance is needed. Identify a formal tool/system to track the RAC Audit Process (notifications, chart requests, recoveries, appeals, etc.). Develop a formal RAC-specific appeals management process with case management, legal and other compliance leadership. 16

18 RAC analysis report from ClinicalAdvisor As part of our RAC risk assessment, we may also utilize Premier s proprietary ClinicalAdvisor RAC risk analysis tool to highlight those inpatient areas at risk for overpayment tto CMSbased on common errors identified din the demonstration ti project. The ClinicalAdvisor RAC tool can then drill down to the specific inpatient areas at risk for overpayment to CMS, and estimate the financial impact based on these errors.

19 Conclusion A valuable opportunity exists to proactively assess the status of your organization s current processes and determine requirements to minimize the risk of RAC errors and Medicare payment recoveries. Benefit and learn from the outcomes of the demonstration project by utilizing that information to prepare for your own RAC audits and assess your current RAC risk. It is essential to have an organized strategy and work plan to determine next steps, formally create a RAC Task Force, and determine how to best manage the Medicare RAC process. 18

20 Next steps In preparation for RAC, perform an assessment of processes that are already in place versus what should be in place to begin to identify any gaps or risk exposures. Once a comprehensive assessment has been completed, you should begin to develop a strategy and work plan to create a RAC Task Force and determine how to best manage the RAC Process based on gaps and opportunities identified in the assessment. 19

21 Questions and discussion 20

22 Contact information FOR MORE INFORMATION, CONTACT US: TODD HALPIN Principal, Premier Consulting Solutions Premier, Inc Cascade Pointe Blvd. Charlotte, NC Phone: MARLOWE DAZLEY Vice President, Premier Consulting Solutions Premier, Inc Cascade Pointe Blvd. Charlotte, NC Phone: Or contact Premier Consulting Solutions at or call the Premier Solution Center at

RAC Preparation 7 Key Steps and Best Practices

RAC Preparation 7 Key Steps and Best Practices McGuireWoods Health Care practice is ranked 6th largest in the country by the American Health Lawyers Association. RAC Preparation 7 Key Steps and Best Practices Elissa K. Moore, Associate 704.343.2218

More information

The Role of the Recovery Audit Contractor

The Role of the Recovery Audit Contractor The Role of the Recovery Audit Contractor Presented by: Franco Signor LLC Brought to you by: Alliance Collection Services, Inc. 6404 Manatee Avenue West, Suite N, Bradenton FL 34209 / 888-959-0692 / www.francosignor.com

More information

Jane Snecinski, FACHE Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com

Jane Snecinski, FACHE Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com Jane Snecinski, FACHE P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com RAC Demonstration Project 3 year demonstration project Greatest impact to IRF from California Issue with greatest impact

More information

How to Successfully Appeal a RAC Audit. Kelly McCloskey Cherf Hogan Marren, Ltd.

How to Successfully Appeal a RAC Audit. Kelly McCloskey Cherf Hogan Marren, Ltd. How to Successfully Appeal a RAC Audit Kelly McCloskey Cherf Hogan Marren, Ltd. General Background RAC - Recovery Audit Contractor The Medicare Prescription Drug, Improvement, and Modernization Act (2003)

More information

Recovery Audit Contractor Program

Recovery Audit Contractor Program Recovery Audit Contractor Program What is a RAC? Recovery Audit Contractor RAC Mission Detect and correct past improper payments so that future improper payments can be prevented: Providers can avoid submitting

More information

Medicare Recovery Audit Contractors

Medicare Recovery Audit Contractors RAC Questions & Answers What is CMS s expansion schedule for the nationwide RAC program? Who will serve as contractors for the nationwide RAC program? Whose claims can be reviewed by the RAC? Aren t RACs

More information

The Recovery Audit Contractor Program: What Every Physical Therapist Needs to Know!

The Recovery Audit Contractor Program: What Every Physical Therapist Needs to Know! The Recovery Audit Contractor Program: What Every Physical Therapist Needs to Know! Physical therapists and providers of physical therapy services in California, Florida, and New York are targets of a

More information

Recovery Auditors and Fee-for-Service Medicare DIVISION OF RECOVERY AUDIT OPERATIONS CENTERS FOR MEDICARE & MEDICAID SERVICES

Recovery Auditors and Fee-for-Service Medicare DIVISION OF RECOVERY AUDIT OPERATIONS CENTERS FOR MEDICARE & MEDICAID SERVICES Recovery Auditors and Fee-for-Service Medicare 1 DIVISION OF RECOVERY AUDIT OPERATIONS CENTERS FOR MEDICARE & MEDICAID SERVICES What is a Recovery Auditor? The Recovery Auditors are CMS contractors who

More information

Revenue Cycle Management Practice

Revenue Cycle Management Practice Revenue Cycle Management Practice W h i t e p a p e r By William Malm, ND, RN Practice Director, Revenue Cycle Management, HCPro, Inc. Recovery audit contractors Recovery Audit Contractors Strategic planning

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 2 nd Quarter 2015

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 2 nd Quarter 2015 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 2 nd Quarter 2015 September 10, 2015 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit

More information

Medicare s Recovery Audit Contractor (RAC) Program

Medicare s Recovery Audit Contractor (RAC) Program Recovery Audit Contractor Update Medicare s Recovery Audit Contractor (RAC) Program HFMA Northern California Spring Conference Rudy Braccili Jr, MBA, CPAM Sr. Director, National Medicare & Medicaid Center

More information

Overview of Hospital Utilization Review

Overview of Hospital Utilization Review Overview of Hospital Utilization Review Legal Authority The Inspector General (IG) hospital utilization review function operates under guidelines and regulations contained in: Texas Administrative Code

More information

Recovery Audit Contractors (RACs) and Medicare. The Who, What, When, Where, How and Why?

Recovery Audit Contractors (RACs) and Medicare. The Who, What, When, Where, How and Why? Recovery Audit Contractors (RACs) and Medicare The Who, What, When, Where, How and Why? 1 Agenda What is a RAC? Will the RACs affect me? Why RACs? What does a RAC do? What are the providers options? What

More information

THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration

THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration June 2008 THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration

More information

MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE

MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE Daniel

More information

Recovery Audit Contractor (RAC) Program Review and Update

Recovery Audit Contractor (RAC) Program Review and Update Recovery Audit Contractor (RAC) Program Review and Update S C O T T W A K E F I E L D P A T R I C I A R O S I N S K I A C A D E M Y O F M E D I C I N E O F C L E V E L A N D & N O R T H E R N O H I O DIVISION

More information

Post-Acute/Long- Term Care Planning for Accountable Care Organizations

Post-Acute/Long- Term Care Planning for Accountable Care Organizations White Paper Post-Acute/Long- Term Care Planning for Accountable Care Organizations SCORE A Model for Using Incremental Strategic Positioning as a Planning Tool for Participation in Future Healthcare Integrated

More information

insights Audits NEW Into Recovery this issue Compliance Tips Designed to help you run your lab more smoothly Starting on Page 13 COLA s

insights Audits NEW Into Recovery this issue Compliance Tips Designed to help you run your lab more smoothly Starting on Page 13 COLA s COLA s March / April 11 insights Into Recovery Audits ALSO IN THIS ISSUE: Letter from the Chair... 2 Recovery Audit Contractors (RAC) Expansion... 3 ICD-10 Upgrade... 4 Physician Office Laboratory Financial

More information

Mount Sinai Medical Center Compliance Department

Mount Sinai Medical Center Compliance Department Mount Sinai Medical Center Compliance Department The Mount Sinai Hospital New York, New York How to Leverage a RAC Committee to Reduce Organizational Risk by Lori Dempsey Director, Hospital Compliance

More information

What Your Organization can do to Avoid the Risks. Jane Snecinski Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.

What Your Organization can do to Avoid the Risks. Jane Snecinski Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors. What Your Organization can do to Avoid the Risks Jane Snecinski P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com Any level of care that occurs after an acute care stay LTAC (Long Term Acute Care

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 2 nd Quarter 2012

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 2 nd Quarter 2012 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 2 nd Quarter 2012 August 22, 2012 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors

More information

WHITE PAPER. Payment Integrity Trends: What s A Code Worth. A White Paper by Equian

WHITE PAPER. Payment Integrity Trends: What s A Code Worth. A White Paper by Equian WHITE PAPER Payment Integrity Trends: What s A Code Worth A White Paper by Equian June 2014 To install or not install a pre-payment code edit, that is the question. Not all standard coding rules and edits

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series

6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

CASE STUDY: St. Joseph Medical Center. Compliance 360 GRC Software Suite

CASE STUDY: St. Joseph Medical Center. Compliance 360 GRC Software Suite CASE STUDY: St. Joseph Medical Center Compliance 360 GRC Software Suite 2 CASE STUDY: St. Joseph Medical Center Background Since June 1, 1887, when the doors opened at Houston s first hospital, St. Joseph

More information

ZPIC, RAC and MAC Audits Proactive vs. Reactive Approach

ZPIC, RAC and MAC Audits Proactive vs. Reactive Approach YOUR DATES HERE YOUR LOGO HERE ZPIC, RAC and MAC Audits Proactive vs. Reactive Approach Lisa Thomson, Vice President Pathway Health 877-777-5463 www.pathwayhealth.com YOUR LOGO HERE OBJECTIVES Understand

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 3 rd Quarter 2012

Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 3 rd Quarter 2012 Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 3 rd Quarter 2012 November 30, 2012 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit

More information

The Real Cost of the Inefficient Medicare RAC Program

The Real Cost of the Inefficient Medicare RAC Program HOSPITAL SURVEY REPORT: The Real Cost of the Inefficient Medicare RAC Program The Recovery Audit Contractor (RAC) program was created by Congress to audit providers Medicare claims to identify overpayments

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

6 Critical Impact Factors of Health Reform on Revenue Cycle Management

6 Critical Impact Factors of Health Reform on Revenue Cycle Management 6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the

More information

SANDY STAMES, RN, BSN, MBA, RAC - CT

SANDY STAMES, RN, BSN, MBA, RAC - CT ALC HEALTHCARE NETWORK, INC. 818.980.4322 CAREER SUMMARY Nursing and business executive with over 25 years experience in healthcare operations and management. Provides executive leadership and consulting

More information

Transfer DRGs: Approaches to Revenue Recovery. A BESLER White Paper

Transfer DRGs: Approaches to Revenue Recovery. A BESLER White Paper Transfer DRGs: Approaches to Revenue Recovery A BESLER White Paper June 2014 Copyright 2014 BESLER Consulting. All rights reserved. *HFMA staff and volunteers determined that Transfer DRG Revenue Recovery

More information

MDaudit Compliance made easy. MDaudit software automates and streamlines the auditing process to improve productivity and reduce compliance risk.

MDaudit Compliance made easy. MDaudit software automates and streamlines the auditing process to improve productivity and reduce compliance risk. MDaudit Compliance made easy MDaudit software automates and streamlines the auditing process to improve productivity and reduce compliance risk. MDaudit As healthcare compliance, auditing and coding professionals,

More information

Ensure that coders and physicians understand the intricacies of medical necessity

Ensure that coders and physicians understand the intricacies of medical necessity Ensure that coders and physicians understand the intricacies of medical necessity JANUARY 14, 2009 JustCoding.com - January 14, 2009 by Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, PCS, FCS, C-CDIS Medical

More information

Deloitte Center for Regulatory Strategies. Balancing act Can hospital CFOs square their medical necessity risks with revenue goals? Here s how.

Deloitte Center for Regulatory Strategies. Balancing act Can hospital CFOs square their medical necessity risks with revenue goals? Here s how. Deloitte Center for Regulatory Strategies Balancing act Can hospital CFOs square their medical necessity risks with revenue goals? Here s how. There s a lot of push-and-pull these days between hospitals

More information

Hospital Client Alert H EALTH M ANAGEMENT A SSOCIATES. January 2009 RAC A UDITS. HMA Team. RAC Overview

Hospital Client Alert H EALTH M ANAGEMENT A SSOCIATES. January 2009 RAC A UDITS. HMA Team. RAC Overview Hospital Client Alert January 2009 H EALTH M ANAGEMENT A SSOCIATES RAC A UDITS HMA Team Health Management Associates (HMA) has assembled an integrated team of financial, clinical, legal and administrative

More information

Additional Documentation Request

Additional Documentation Request Additional Documentation Request Complex Review and Concept Development Date Provider Provider Address Provider City and State Re: Provider #123456789 Letter ID: XXXXXX The Centers for Medicare & Medicaid

More information

Continuous Quality Monitoring

Continuous Quality Monitoring Continuous to Maximize ICD-10 Proficiency and Organizational Benefits 1 2 The New Role of 3 Continuous ! A common strategy to maintain coding accuracy, continuous quality reviews have taken on greater

More information

Helping Physicians Drive Better Practice Health

Helping Physicians Drive Better Practice Health McKesson Business Performance Services Revenue Cycle Management Services Helping Physicians Drive Better Practice Health McKesson Business Performance Services Our staff of 7,000+ includes 500+ certified

More information

Risk Adjustment ABC s

Risk Adjustment ABC s Medicare Advantage Risk Adjustment and Coding Academy Coding Risk Adjustment Documentation Training Risk Adjustment ABC s What is Risk Adjustment? Risk adjustment is the process by which the Medicare &

More information

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle

Rejection Prevention. How Actionable Data Can Drive Results in Your Revenue Cycle Rejection Prevention How Actionable Data Can Drive Results in Your Revenue Cycle Objectives Build a data collection strategy in denials and rejections that drives action and ultimately improved results

More information

HMS Announces Definitive Agreement To Acquire HDI

HMS Announces Definitive Agreement To Acquire HDI HMS Announces Definitive Agreement To Acquire HDI November 7, 2011 Bill Lucia, President and CEO Walter Hosp, SVP and CFO Contact: Christine Saenz csaenz@hms.com 212.857.5986 Safe Harbor Statemente t This

More information

7 th National RAC (and MAC) Summit December 5 6, 2012 Washington, DC

7 th National RAC (and MAC) Summit December 5 6, 2012 Washington, DC 7 th National RAC (and MAC) Summit December 5 6, 2012 Washington, DC Jane Snecinski P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com National client base (both public and private sector) based

More information

Helping You Achieve Better Clinical and Financial Health

Helping You Achieve Better Clinical and Financial Health McKesson Business Performance Services Accountable Care Services Helping You Achieve Better Clinical and Financial Health 1 We recognized that fee-for-service would decrease and value-based care would

More information

Recovery Audit Contractor Audits: What You Need to Know

Recovery Audit Contractor Audits: What You Need to Know Recovery Audit Contractor Audits: What You Need to Know August 19-21, 2009 Gulfport Hattiesburg Meridian Jackson Kosciusko Presented by: Jeff Moore Phelps Dunbar LLP jeff.moore@phelps.com Materials PowerPoint

More information

When it Comes to ICD-10, Preparation is Everything

When it Comes to ICD-10, Preparation is Everything When it Comes to ICD-10, Preparation is Everything Addressing ICD-10 s negative revenue impacts before they happen Steven R. Gerst, MD, MBA, MPH, CHE Jvion Senior Medical Advisor Atlanta, GA Darien, CT

More information

RAC Auditing Reform is Essential to Fix Urgent, Critical Problems

RAC Auditing Reform is Essential to Fix Urgent, Critical Problems RAC Auditing Reform is Essential to Fix Urgent, Critical Problems Recovery Audit Contractors (RACs) audit Medicare claims submitted by hospitals and other health care providers. They are one of many different

More information

THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse

THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse TRUE OR FALSE: One coding audit a year of a random sample of 30 charts per coder is sufficient

More information

Road Map Identifying Financial Opportunities Through Data Analytics

Road Map Identifying Financial Opportunities Through Data Analytics Optimizing the business of healthcare ROAD MAP Road Map Identifying Financial Opportunities Through Data Analytics Identifying Financial Opportunities Through Data Analytics How important is collecting,

More information

Accountable Care Organizations: Reality or Myth?

Accountable Care Organizations: Reality or Myth? Written by: Ty Meyer Accountable Care Organizations: Reality or Myth? Introduction According to Steven Gerst, VP of Medical Affairs at MedCurrent Corporation, The Patient Protection and Affordable Care

More information

Health Information Technology and Management

Health Information Technology and Management Health Information Technology and Management CHAPTER 12 Management and Decision Support Systems Pretest (True/False) Integrated systems require HL7 to exchange information with other healthcare systems.

More information

2013 Healthcare Compliance Benchmark Study

2013 Healthcare Compliance Benchmark Study 2013 Healthcare Compliance Benchmark Study Presented By: and Executive Summary Beginning in early December of 2012, Compliance 360 (now part of SAI Global), conducted a survey among compliance professionals

More information

RACs AND THE MEDICARE AND MEDICAID APPEALS PROCESS

RACs AND THE MEDICARE AND MEDICAID APPEALS PROCESS RACs AND THE MEDICARE AND MEDICAID APPEALS PROCESS Lorman Educational Services Independence, Ohio Presenter Thomas W. Hess Dinsmore & Shohl LLP 191 W. Nationwide Blvd., Suite 300 Columbus, Ohio 43215 Phone:

More information

Revenue Cycle Management

Revenue Cycle Management Revenue Cycle Management Manage and Improve Your Results with Origin RCM Financial pressures are escalating for both healthcare providers and patients. In this challenging climate, a wellmanaged revenue

More information

EXECUTIVE ALERT THE TORTURE RAC. Target Areas

EXECUTIVE ALERT THE TORTURE RAC. Target Areas EXECUTIVE ALERT THE TORTURE RAC March 12, 2009 As providers nationwide prepare for the impact of the March 1, 2009, rollout of the Medicare recovery audit contractor (RAC) permanent program, they should

More information

Inpatient or Outpatient Only: Why Observation Has Lost Its Status

Inpatient or Outpatient Only: Why Observation Has Lost Its Status Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning

More information

3M Health Information Systems Solutions Overview. Navigating change... across the continuum of care

3M Health Information Systems Solutions Overview. Navigating change... across the continuum of care 3M Health Information Systems Solutions Overview Navigating change... across the continuum of care Integrated, enterprise-wide solutions Most people know us for our market-leading coding and grouping products,

More information

Care Transformation and the Journey to Population Health Management

Care Transformation and the Journey to Population Health Management Care Transformation and the Journey to Population Health Management Richard A Bankowitz, MD MBA FACP Chief Medical Officer, Premier healthcare alliance AMGA Institute for Quality September 26, 2013 Premier:

More information

Fraud & Abuse: Part 2

Fraud & Abuse: Part 2 Fraud & Abuse: Part 2 This article was developed from a presentation by Stephen M. Levine, PT, DPT, MSHA, a partner in Fearon & Levine Consulting, at the 2013 FSBPT annual meeting. How some therapists

More information

HEALTHCARE REFORM OCTOBER 2012

HEALTHCARE REFORM OCTOBER 2012 HEALTHCARE REFORM Tracking ACO Growth Nationally OCTOBER 2012 The enclosed slides are intended to provide you with a snapshot of how private sector accountable care organizations (ACOs) have formed since

More information

MEDICAL AUDITS: TOP TEN TIPS FOR PHYSICIANS TO ANTICIPATE, RESPOND AND PROTECT THEIR PRACTICES

MEDICAL AUDITS: TOP TEN TIPS FOR PHYSICIANS TO ANTICIPATE, RESPOND AND PROTECT THEIR PRACTICES MEDICAL AUDITS: TOP TEN TIPS FOR PHYSICIANS TO ANTICIPATE, RESPOND AND PROTECT THEIR PRACTICES The pressure on both governmental and private payers to reduce the cost of healthcare and the often mistaken,

More information

January 14, 2011. Dear Chairman Issa:

January 14, 2011. Dear Chairman Issa: The Honorable Darrell Issa Chairman Committee on Oversight and Government Reform U.S. House of Representatives 2157 Rayburn House Office Building Washington, D.C. 20515 Dear Chairman Issa: On behalf of

More information

Frequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013

Frequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013 Frequently Asked Questions Recovery Auditor Outpatient Therapy Claims As of April 17, 2013 1. Q. Why is CMS conducting manual review on therapy claims? A. On January 2. 2013 President Obama signed into

More information

Physician Discovery Services Provide a Full Range of Physician Practice Solutions

Physician Discovery Services Provide a Full Range of Physician Practice Solutions Physician Discovery Services OUR SOLUTION Truven Health Physician Discovery Services experts provide insights into a hospital or health system s physician enterprise. With experience in physician assessment,

More information

PADONA DON CERTIFICATION PREP COURSE

PADONA DON CERTIFICATION PREP COURSE PADONA DON CERTIFICATION PREP COURSE September 29 & 30 and October 1 & 2, 2015 COURTYARD MARRIOTT 651 Fountain Road Plymouth Meeting, PA 19462 DON Certification Prep Course - 2015 DAY 1 Tues. Sept. 29,

More information

The Fraud and Abuse Environment for Anesthesiologists

The Fraud and Abuse Environment for Anesthesiologists The Fraud and Abuse Environment for Anesthesiologists Jointly Sponsored By: Anesthesia Business Consultants, LLC Tulane University School of Medicine Department of Anesthesiology The Center for Continuing

More information

Physician Enterprise The Importance of Charge Capture, Business Intelligence and Being a Data Driven Organization

Physician Enterprise The Importance of Charge Capture, Business Intelligence and Being a Data Driven Organization Physician Enterprise The Importance of Charge Capture, Business Intelligence and Being a Data Driven Organization Executive Summary Physician-hospital alignment is a key strategy for most hospitals across

More information

Conifer Health Solutions Tenet Investor Webinar

Conifer Health Solutions Tenet Investor Webinar Conifer Health Solutions Tenet Investor Webinar May 16, 2012 Stephen Mooney President, Conifer Health Solutions 1 2012 Conifer Health Solutions, LLC. All Rights Reserved. Forward Looking Statements Certain

More information

and the Mechanics of MICHAEL K. HARRINGTON, MSHA, RHIA, CHP Faculty Department of Health Administration St. Joseph's College of Maine Standish, Maine

and the Mechanics of MICHAEL K. HARRINGTON, MSHA, RHIA, CHP Faculty Department of Health Administration St. Joseph's College of Maine Standish, Maine HEALTH CARE FINANCE and the Mechanics of Insurance and Reimbursement MICHAEL K. HARRINGTON, MSHA, RHIA, CHP Faculty Department of Health Administration St. Joseph's College of Maine Standish, Maine Ä-

More information

EHR Client Bulletin: Answers to Your Most Frequently Asked Condition Code 44 Questions

EHR Client Bulletin: Answers to Your Most Frequently Asked Condition Code 44 Questions EHR Client Bulletin: Answers to Your Most Frequently Asked Condition Code 44 Questions Originally Issued On: February 25, 2010 Last Update: February 20, 2013 UPDATE: The following EHR Client Bulletin was

More information

THE NEW ENVIRONMENT FOR FRAUD & ABUSE ENFORCEMENT FOR ANESTHESIA & PAIN MANAGEMENT

THE NEW ENVIRONMENT FOR FRAUD & ABUSE ENFORCEMENT FOR ANESTHESIA & PAIN MANAGEMENT THE NEW ENVIRONMENT FOR FRAUD & ABUSE ENFORCEMENT FOR ANESTHESIA & PAIN MANAGEMENT Presented by Abby Pendleton, Esq. The Health Law Partners, P.C. Karin Bierstein, JD, MPH Anesthesia Business Consultants,

More information

Capacity Management: Patient Throughput and Case Management Improvement. February 25, 2015

Capacity Management: Patient Throughput and Case Management Improvement. February 25, 2015 Capacity Management: Patient Throughput and Case Management Improvement February 25, 2015 Agenda Introduction Impetus for Change Approach to Improving Case and Capacity Management Client Case Study Key

More information

Retrospective Denials Management

Retrospective Denials Management Retrospective Denials Management Weaving together the Clinical, Technical, and Legal Components Glen Reiner, RN, BSN, VP of Clinical Operations Nicole Guido, VP Business Development Our goals for our time

More information

Regulatory Updates for Outpatient Rehab + Documentation Audit - Next Steps

Regulatory Updates for Outpatient Rehab + Documentation Audit - Next Steps Regulatory Updates for Outpatient Rehab + Documentation Audit - Next Steps P.J. Rhoades PT, DPT, MS, CHC Director of Compliance and Denials Management Objectives Discuss changes in regulation for outpatient

More information

Indiana State Medical Association Coalition Meeting May 23, 2014

Indiana State Medical Association Coalition Meeting May 23, 2014 Indiana State Medical Association Coalition Meeting May 23, 2014 Coalition Topics 1. Due to the increased number of billing errors with new patients, please provide a reminder of when a patient is a new

More information

How to Prepare a Winning RAC Appeal

How to Prepare a Winning RAC Appeal How to Prepare a Winning RAC Appeal Craneware InSight Consulting Copyright 2011, CRANEWARE INSIGHT. All rights reserved. www.cranewareinsight.com p.1 Introduction Introductions Karen Bowden, RHIA, Senior

More information

Early Lessons learned from strong revenue cycle performers

Early Lessons learned from strong revenue cycle performers Healthcare Informatics June 2012 Accountable Care Organizations Early Lessons learned from strong revenue cycle performers Healthcare Informatics Accountable Care Organizations Early Lessons learned from

More information

Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings

Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Ten Overlooked Opportunities For Significant Performance Improvement and Cost Savings Huron Healthcare s Performance

More information

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014

Accountable Care Communities 101. Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Accountable Care Communities 101 Jennifer M. Flynn, Esq. Senior Director, State Affairs Premier healthcare alliance January 30, 2014 Premier is the largest healthcare alliance in the U.S. Our Mission:

More information

West Penn Allegheny Health System

West Penn Allegheny Health System West Penn Allegheny Health System System Compliance Department Medical Necessity and Billing for Inpatient Rehabilitation Lessons Learned from an Inpatient Rehab Unit Billing Audit 2006 HCCA Compliance

More information

HIPAA Secure Now! How MSPs Can Profit From Selling HIPAA security services

HIPAA Secure Now! How MSPs Can Profit From Selling HIPAA security services HIPAA Secure Now! How MSPs Can Profit From Selling HIPAA security services How MSPs can profit from selling HIPAA security services Managed Service Providers (MSP) can use the Health Insurance Portability

More information

DocuComp LLC 2012 Educational Seminar Catalog

DocuComp LLC 2012 Educational Seminar Catalog Certification in Clinical Documentation Improvement & Integrity Program Certified Professional in Denials & Appeals Management Program Physician Advisor in Clinical Documentation Improvement & Integrity

More information

Solution Overview. Fusion Health Advantage Big Data Accelerator Platform

Solution Overview. Fusion Health Advantage Big Data Accelerator Platform Solution Overview Fusion Health Advantage Big Data Accelerator Platform Improve Patient Outcomes And Manage Them Cost Effectively Healthcare reform measures have intensified governmental scrutiny, thereby

More information

Audits: Know your risks and Get prepared

Audits: Know your risks and Get prepared Objectives Audits: Know your risks and Get prepared 1. Establish familiarity with various audit contractors and identify variances in their audit processes 2. Understand documentation guidelines and requirements

More information

ICD-10 Compliance Date

ICD-10 Compliance Date ICD-10 Implementation Frequently Asked Questions Updated September 2015 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,

More information

CAH Revenue Cycle Assessment Project 2012

CAH Revenue Cycle Assessment Project 2012 CAH Revenue Cycle Assessment Project 2012 Our Mission: To protect and improve the health and environment of all Kansans. The first step in improving a process is measuring current performance. How did

More information

Exploring the Impact of the RAC Program on Hospitals Nationwide

Exploring the Impact of the RAC Program on Hospitals Nationwide Exploring the Impact of the RAC Program on Hospitals Nationwide Overview of AHA RACTrac Survey Results, 4 th Quarter 2010 For complete report go to: http://www.aha.org/aha/issues/rac/ractrac.html Agenda

More information

Shellie Sulzberger, LPN, CPC, ICDCT-CM. Coding & Compliance Initiatives, Inc.

Shellie Sulzberger, LPN, CPC, ICDCT-CM. Coding & Compliance Initiatives, Inc. Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. My connection to coding and documentation My connection to clinical processes My connection to ICD-10 My connection to YOU Coding

More information

Evaluating Your Hospitalist Program: Key Questions and Considerations

Evaluating Your Hospitalist Program: Key Questions and Considerations Evaluating Your Hospitalist Program: Key Questions and Considerations Evaluating Your Hospitalist Program: Key Questions and Considerations By Vinnie Sharma, MBA, MPH Manager, Physician Advisory Services

More information

Center for Program Integrity

Center for Program Integrity Center for Program Integrity Peter Budetti, Deputy Administrator Director, Center for Program Integrity National Conference of State Legislators Spring Forum April 14, 2011 Center for Program Integrity

More information

Optimizing Clinical Documentation Improvement AT THE INTERFACE OF CLINICAL OPERATIONS AND THE REVENUE CYCLE

Optimizing Clinical Documentation Improvement AT THE INTERFACE OF CLINICAL OPERATIONS AND THE REVENUE CYCLE Optimizing Clinical Documentation Improvement AT THE INTERFACE OF CLINICAL OPERATIONS AND THE REVENUE CYCLE Optimizing Clinical Documentation Improvement AT THE INTERFACE OF CLINICAL OPERATIONS AND THE

More information

September 2, 2014. Dear Chairman Brady:

September 2, 2014. Dear Chairman Brady: The Honorable Kevin Brady Chairman U.S. House Committee on Ways and Means, Subcommittee on Health 1135 Longworth House Office Building Washington, DC 20515 Dear Chairman Brady: On behalf of our nearly

More information

How CDI is Revolutionizing the Transition to Value-Based Care

How CDI is Revolutionizing the Transition to Value-Based Care How CDI is Revolutionizing the Transition to Value-Based Care How CDI is Revolutionizing the Transition to Value-Based Care Creating a state-of-the-art clinical documentation improvement (CDI) program

More information

Hospital Rehab Management

Hospital Rehab Management Why Heritage Healthcare as Your Rehab Delivery Partner? Hospitals are seeking collaborative partner relationships to better position them for the current environment, as well as tomorrow s increasing challenges.

More information

ICD-10 Frequently Asked Questions for Providers

ICD-10 Frequently Asked Questions for Providers FAQ Sections: ICD-10 Claims Billing and Coding ICD-10 Testing ICD-10 Issues Resolution Processes ICD-10 Training and Resources ICD-10 Claims Billing and Coding Will you be ready to accept ICD-10 codes

More information

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit

Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician

More information

The Financial Case for EHR/RCM Integration. White Paper. The Power of Clinically Driven Revenue Cycle Management. Presented by

The Financial Case for EHR/RCM Integration. White Paper. The Power of Clinically Driven Revenue Cycle Management. Presented by The Financial Case for EHR/RCM Integration The Power of Clinically Driven Revenue Cycle Management White Paper Presented by The Financial Case for EHR/RCM Integration The Power of Clinically Driven Revenue

More information

Provider Audit. Charlotte Benson. CMS, Office of Financial Management, Financial Services Group

Provider Audit. Charlotte Benson. CMS, Office of Financial Management, Financial Services Group Provider Audit Charlotte Benson CMS, Office of Financial Management, Financial Services Group June 18, 2014 Provider Audits Cost Report Audits HITECH Payment Audits HITECH Meaningful Use Audits 2 Medicare

More information

THE NEW COSTS OF UNIONIZATION

THE NEW COSTS OF UNIONIZATION THE NEW COSTS OF UNIONIZATION THE NEW COSTS OF UNIONIZATION IN HEALTHCARE UNION ELECTIONS AND REPRESENTATION: LOWER HCAHPS SCORES AND INCREASE READMISSION RATES New Research Demonstrates Significant Financial

More information

Revenue Cycle Assessment

Revenue Cycle Assessment Revenue Cycle Assessment Your Challenge Maintaining the status quo can be costly. As health care operating margins shrink, hospitals need to find efficient and innovative ways to capture and collect revenues.

More information