Recovery Audit Contractor Update and New Issues for 2019

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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, April 2
12:30 - 2 p.m.

Register on or before Thursday, March 28, 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. Get more value by inviting colleagues to join you on the one connection.

This webinar is being offered at a reduced registration fee to MHA-member hospitals thanks to a generous 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 status of Recovery Audit Contractor activities, along with consideration to new contracts, scope of works and various RAC-approved issues.

Included in this program will be events surrounding RACs and the backlog of appeals at the Administrative Law Judge and Medicare Appeals Council level. The Office of Medicare Hearings and Appeals proposed several different ways to address their enormous backlog of appeals, including statistical extrapolation, settlement conferences and administrative agreements.

A main concern is medical necessity for inpatient admissions. The inpatient issues have sparked the development of the ‘Over Two-Midnights’ rule. CMS proposed changes to the appeals process to expedite the resolution of the backlog of appeals. The expansion of RACs to the Medicare Advantage programs still is working with the Risk Adjustment Data Validation, with a concentration on both comprehensive and condition-specific issues.


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

Duane C. Abbey, Ph.D. has provided health care consulting services to hospitals, physicians and medical clinics for more than two decades.

His focus is in the areas of compliance, and payment and delivery systems. In addition to consulting, he is an invited presenter for hospital associations, medical societies and other professional groups. Dr. Abbey is an established health care author.