RAC Update and New Issues for 2018
This workshop is devoted to reviewing the current status of Recovery Audit Contractor (RAC) activities along with due consideration to the new contracts, scope of works, and various RAC approved issues.
Included in this program will be recent events surrounding the RACs and the backlog of appeals at the Administrative Law Judge (ALJ) and Medicare Appeals Council (MAC) level. OMHA has proposed several different ways to address their enormous backlog of appeals including statistical extrapolation, settlement conferences, and administrative agreements. One of the main issues is that of medical necessity for inpatient admissions. The inpatient issues have sparked the development of the ‘Over 2‐Midnights’ rule. CMS has also proposed changes to the appeals process in order to expedite the resolution of the backlog of appeals. The expansion of the RACs to the Medicare Advantage Programs is still in the works with the Risk Adjustment Data Validation (RADV) with a concentration on both comprehensive and condition‐specific issues.