Education event

RAC Medical Necessity Review — Preparation and Response, Web Seminar
Medicare guidelines on medical necessity, RAC review process, claims adjustments

August 3, 2011
10:00 a.m. – Noon, Pacific Time



In the fall of 2010, the Centers for Medicare & Medicaid Services (CMS) approved reviews of “medical necessity” in the Recovery Audit Contractor (RAC) Program. Since that time, hospitals nationwide have received numerous medical record requests and subsequent denials of inpatient claims for medical necessity. The most commonly cited reason for denial? Patient care would have been more appropriately provided in an outpatient setting. To date, California hospitals have reported losses of $30 million in “take-backs” — payments they can ill-afford to lose.

To help hospitals better understand and prepare for RAC review, CMS, in conjunction with Medicare Administrative Contractor, Palmetto GBA, and RAC, Health Data Insights, will share information about the criteria for inpatient admission and process for review. Specifically, faculty will explain:

  • Rules related to Complex Reviews
  • Program findings — amount of reviews and denials, recoveries to date
  • Medicare guidelines on medical necessity — what the RACs look for
  • Tools the RAC uses to assess medical necessity
  • Demand letters, take-backs and the claims adjustment process
  • Discussion period — timelines and process, what can and can’t happen
  • Appealing the decision — levels of appeal, protocols, timeframes
  • And more.

Recommended for:
Chief Financial Officers, Chief Compliance Officers, Revenue Cycle Directors, Business Office Managers, RAC Coordinators, Case Managers



From Centers for Medicare & Medicaid Services:
LCDR Brian Elza, PT, DPT, OCS, CSCS, Health Insurance Specialist, Recovery Audit Program, and
Narcessa M. Chesil, Health Insurance Specialist, Region D Project Officer

From Palmetto GBA:
Harry Feliciano, MD, MPH, Contractor Medical Director, and
Ruby Reed-Knighton, Ombudsman Part A, J1 California

From Health Data Insights:
Mary Woon, Vice President, Account Management






Members $185 (per connection)
Nonmembers $250 (per connection)

Multiple staff can gather and participate from one location for one tuition fee. Register online using the button on the right or complete the registration form and fax it to (916) 552-7506. The program is limited to 300 connections. Checks should be made payable to CAHHS/CHA and mailed to:

California Hospital Association
Education Department
1215 K Street, Suite 800
Sacramento, CA 95814

Cancellation Policy
A $50 non-refundable processing fee will be retained for each cancellation. Cancellations must be made in writing seven days prior and emailed to, or faxed to (916) 552-7506. No refunds will be made after this date. If the seminar is cancelled paid participants will be fully refunded within 30 days.

Access Info

This web seminar allows you to attend and participate without ever leaving the office. The seminar is produced live, via the Internet and a telephone line. You only need a telephone and a computer with a web browser to participate.

Once you register, a confirmation e-mail will be sent with pertinent program information.

Audio for the seminar is accessed through a toll-free number (U.S. calls only). During the program, you will have the opportunity to ask questions of the speakers. If multiple people will be listening to the program at your office, only one person needs to register for the group. The slide presentation is accessed on your computer via the web.

IMPORTANT: Test your computer today

  • Click here to go to the Adobe Connect Enterprise Server Connection test page.
  • Follow instructions to ensure that your computer and network connections are properly configured.

If your internal security settings block access to Adobe Connect, contact your IT department to grant you access. The web seminar runs on Adobe Connect and you won’t be able to view the program without access.


Click here to view attendees.