General Information

Web Seminar Will Cover RAC Process and Expectations for Medical Necessity Reviews

Since the Centers for Medicare & Medicaid Services (CMS) approved Recovery Audit Contractor (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, CHA will hold a web seminar featuring leadership from CMS; Palmetto GBA, the Medicare Administrative Contractor; and Health Data Insights, the RAC for California hospitals.

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

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

The 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