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Federal Appeals Process for RAC Determinations of Improper Payment: What Every Hospital Must Know!
Webinar
March 25, 2010
Time: 12 - 1 pm CENTRAL TIME
Register for this event online:
March 25, 2010 ($225 per line)
Program Description
This webinar presents a description of the federal administrative appeals process applicable when a Medicare contractor denies a claim for reimbursement. The presentation includes a description of the process used by Medicare contractors, (FIs, MACs, and RACs) to make determinations of improper payments, including their procedures for making additional document requests ("ADR"s). The rights of hospitals in this process will be discussed. The procedures for appealing RAC determinations will be explained and practice tips will be offered on avoiding pitfalls in the process, preventing recoupment of alleged overpayments before the appeal is decided; and on persuasively addressing "medical necessity" issues.
Program Topics
- Types of post-payment reviews and audits Medicare Contractors perform
- A description of the procedures used by Medicare contractors to request additional documents from providers
- Four levels of administrative appeal available to providers aggrieved by claims denials, with a discussion of the features unique to each level
- Essential elements of a request for administrative appeal
- Limitations on Medicare's ability to recoup funds from providers during the administrative appeals process
Learning Objectives
Attendees of this program will be able to:
- Identify the essential elements of a request for appeal
- Discuss the four levels of administrative appeal and certain pitfalls that exist in the process
- List the steps to take to prevent recoupment of the disputed funds during the first two levels of appeal
Who Should Participate
RAC contact, CFO, all coding, billing and reimbursement staff, financial analysts, compliance officers and legal counsel
Faculty
Mark Guza
Arnall, Golden, Gregory LLP
Mark Guza joined Arnall, Golden, Gregory LLP (AGG) from the Office of General Counsel of the Department of Health and Human Services, where he developed extensive experience in a wide variety of regulatory compliance matters involving health care providers. Guza's practice with the Government included litigation of Medicare and Medicaid reimbursement disputes, civil money penalties, termination of Medicare provider agreements, health planning and certificate of need issues, as well as Inspector General exclusions. During his last several years with the Office of General Counsel, he supervised a team of nine attorneys responsible for enforcement litigation of health care provider regulatory matters. At AGG, he continues practicing in a wide scope of health care regulatory matters, including litigation of Medicare and Medicaid reimbursement issues, and civil money penalties, as well as counseling providers on Stark and Anti-kickback Statute issues, EMTALA compliance and medical staff issues. He has extensive experience in administrative appeals matters with Medicare and Medicaid claims. He graduated cum laude from the University of Georgia School of Law in 1974.
The views expressed by the speaker do not necessarily reflect the policies or opinions or the Wisconsin Hospital Association.
Registration Information
Fee
$225.00 for one phone line per site
Please register only one name per connection.
Additional phone lines will be billed at $225.00 each.
How the Webinar Will Work
Dial-in instructions, on-line login instructions and any other reference materials will be emailed to each registrant approximately three days prior to the conference. If you do not receive them by this date, please email llittel@wha.org.
It is the responsibility of the registrant to access presentation materials prior to the day of the event. If your e-mail address changes, you do not receive an e-mail with instructions from WHA, or if you are unable to open presentation materials, please contact Lisa Littel at WHA two days prior to the event to allow time to address the issue.
Substitution, Transfer and Cancellation Policy
Cancellations received in writing up to five business days prior to an event will be given a full refund less a $50 processing fee. No refunds will be given for cancellations received less than five business days prior and day-of-program no-shows. Substitutions are accepted.
Register for this event online:
March 25, 2010 ($225 per line)
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