Education event

Web Seminar Will Explain Guidelines and Process for RAC Medical Necessity Reviews

CHA will hold a web seminar Aug. 3 from 10 a.m. to noon (PT) to help hospitals better understand and prepare for Recovery Audit Contractor (RAC) medical necessity reviews.

In 2010, the Centers for Medicare & Medicaid Services (CMS) approved RAC reviews of “medical necessity.” 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 has been that care would have been more appropriately provided in an outpatient setting. Denial of payment has been costly for California hospitals with reported losses of $30 million in “take-backs.”

Web seminar participants will gain valuable information regarding the criteria for inpatient admission and process for review, rules related to complex reviews, what RACs look for and tools used to assess medical necessity. The claims adjustment process, take-backs and levels of appeal also will be covered.

Faculty for the program will include LCDR Brian Elza, health insurance specialist, Recovery Audit Program, and Narcessa Chesil, health insurance specialist, Region D Project Officer, with CMS; Harry Feliciano, MD, contractor medical director, and Ruby Reed-Knighton, ombudsman Part A, J1 California, with Palmetto GBA; and Mary Woon, vice president, account management, with Health Data Insights.

Tuition for the program is $185 for members and $250 for nonmembers. For more information or to register, go to