Recovery Audit Contractor Update and New Issues for 2018

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Start Time:12:00 AM
End Time:12:00 AM
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Provided by MHA Health Institute
Health Institute

Date & Time

Tuesday, March 6
12:30 - 2 p.m.

Register on or before Tuesday, Feb. 27, to ensure delivery of instructional materials.

MHA members — $225
Nonmembers — $275

The webinar registration fee is for one phone line connection. Each additional phone line connection will be charged a registration fee. Multiple participants on the same connection is encouraged. Get more value by inviting colleagues to join you!

This webinar is being offered at a reduced registration fee to MHA-member hospitals because of a contribution from the MHA Management Services Corporation.


All personnel involved with patient status, including physicians, clinical personnel, utilization review staff, compliance and management personnel, coding/billing employees, and all others involved with inpatient admission and observation services.

The following program content was provided by the speaker.


This workshop is devoted to reviewing the current status of Recovery Audit Contractor 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 and Medicare Appeals Council level. The Office of Medicare Hearings and Appeals 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 Two‐Midnights’ rule. CMS also has 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 with a concentration on both comprehensive and condition‐specific issues.


At the completion of this program, participants will be able to:

  • discuss the current status of the Recovery Audit Contractor program
  • identify the different Statement of Works for five regions
  • define the role of the administrative law judges and the Medicare Appeals Council
  • discuss the Centers for Medicare & Medicaid Services proposed changes in the appeals process
  • discuss the settlement process and administrative agreements
  • analyze the 'Over Two-Midnights' rule and the sub regulatory guidance being issued, including Quality Improvement Organization involvement


Duane C. Abbey, Ph.D.
Abbey & Abbey Consultants, Inc.
Ames, Iowa

Dr. Duane Abbey is a management consultant and president of Abbey & Abbey Consultants. For more than 20 years, Dr. Abbey has provided health care consulting services to hospitals, physicians and medical clinics. The focus of his consulting has been in the areas of compliance, payment and delivery systems. In addition to his consulting, Dr. Abbey is an invited presenter for hospital associations, medical societies and other groups. He also has published articles and books on health care topics. The speaker has no real or perceived conflicts of interest that relate to this presentation.