Updated on: June 22, 2012

RAC Chatter From the HFMA ANI in Seattle – Day Two

Original story posted on: June 16, 2009



By Dennis Jones


SEATTLE -- It was about 8:45 a.m. Tuesday when Al Gore appeared on stage. He got a rock star greeting. While addressing healthcare issues and concerns, Mr. Gore depended on his notes, and his presentation seemed a bit labored. But when he transitioned from the slow-moving progress in healthcare to the slow-moving progress in environmental issues, he hit his stride, literally and figuratively. No longer anchored to the podium, the former Vice President moved around the stage like Springsteen at the Super Bowl. He was animated, he was thoughtful, he was great. He even told a humorous Richard Nixon anecdote.


And then he described a dire environmental future. It's not just the melting of the polar ice caps that threatens humanity, he said, it's the subsequent release of a "carbon time-bomb" that would have an even more catastrophic impact. Yikes! This apocalyptic vision was killing all of the good vibes from yesterday. Nonetheless, shaken but motivated, I joined the near-capacity crowd in a spontaneous standing ovation.



Unlike during Day One, when you really had to seek out RAC-based breakout sessions, on Day Two it seemed as if you could wander into almost any room and confront some aspect of our RAC future.


The most popular RAC session of the day appeared to be the one provided by Drs. Rob Corrato and Tom McCarter of EHR and Lynne Leoce, MSN and RN of Adventist Health System in Florida. The room was beyond capacity and the presentation was polished and crammed with useful information.


At the same time, in an adjacent room, Jeff Wajda of LYNX Medical Systems was presenting his own session, titled "Using Effective UR Management to Improve ED Reimbursement."  The impact of the RACs in ED treatment and reimbursement was featured.


Meanwhile, down the hall, Debbie Schrubb (RHIA from Kettering Health Network) and Mark Weber (Senior Regulatory Analyst from 3M) were presenting "Implementing an Effective Medical Necessity Validation Process."


After lunch, Bobette Gustafson of Gustafson & Associates presented "Achieving Total Revenue Cycle Regulatory Compliance" while Francine Machisko of Noblis and Amy Fouts of McKenna Long & Aldridge LLP addressed RAC and MIC (Medicaid Integrity Contractor) issues.


All the presentations were good - some were just noticeably better than others. One problem when so many entities are covering the same topic is that you can't escape the repetitive recitation of certain items - in this case, the RAC Demonstration Program background, which often was provided in excruciating detail. It would be great if there could be a "RAC 101" class for beginners to get the basics out of the way and subsequently free the other presenters to provide graduate-level RAC topics.


Also, when different entities from different disciplines are covering the same topic, it can remind you of the old tale about blind men describing an elephant. Your understanding of the beast's description depends on which part of it you hear about (it seems that the ED is like the messy part of the elephant you don't want to go near, but you just have to.)


And although most of the information presented was accurate, helpful and sometimes insightful, some was just not right. There were some statements made about the appeal process, RAC time frames, MSP review (?!) and the "discussion" period that I hope people aren't planning on sharing with others in their own RAC committees.


After a full day of being battered by a much gloomier perspective of the RAC program, I feel that the whole thing is going to be even worse and more complex than I thought.  The optimism of yesterday is gone; the impression that RAC audits are going to be a long, hard war of attrition persists.


Back to reality in Seattle. As I go outside it looks like it's about to rain. I just hope that isn't a carbon time-bomb I smell out there in the frozen tundra.


About the Author


Dennis Jones is the director of revenue cycle clinical support services with CBIZ KA Consulting Services LLC. His expertise covers a wide variety of topics including managed care, uncompensated care, Medicare compliance, HIPAA and process improvement. He is a recognized speaker having previously addressed the New Jersey Hospital Association, World Research Group and various state chapters of HFMA, AAHAM and AHIMA. His expertise in Medicare compliance has been an integral component of the CBIZ RAC solution.


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