General Information

RAC Medical Necessity Review Seminar Set for Aug. 3

Leaders from the Centers for Medicare & Medicaid Services (CMS), and the Medicare Administrative Contractor (MAC) and Recovery Audit Contractor (RAC) programs will explain the review process criteria for “medical necessity” at an upcoming CHA web seminar. Since CMS approved RAC audits for “medical necessity,” California hospitals have experienced payment denials of more than $30 million.

To help hospitals better understand and prepare for RAC review, the web seminar will feature leadership from CMS, Palmetto GBA and Health Data Insights, the RAC for California hospitals. Speakers will be LCDR Brian Elza, health insurance specialist, RAC Program, and Narcessa Chesil, health insurance specialist, Region D Project Officer, for CMS; Harry Feliciano, MD, medical director, and Ruby Reed-Knighton, ombudsman Part A, J1 California, for Palmetto GBA; and Mary Woon, vice president, account management, for Health Data Insights.

Participants will gain valuable information regarding the criteria for the inpatient admission and review process, 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.

The RAC Medical Necessity Review seminar will be held Aug. 3 from 10 a.m. to noon (PT). Tuition for the program is $185 for members and $250 for nonmembers. For more information or to register, go to www.calhospital.org/rac-mn-web.

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