How CMS Plays the Game – or – The House Always Wins

Stacking the Deck

How You Can Prepare To Fight Them, BEFORE the Boot Camp

Between the rising rate of hospital audits by RACs, MACs, Medicare Advantage Plans, and even State Medicaid RACs, not to mention the most recently posted rulings by CMS to change the way providers get paid and who can decide appeals or not, you and your audit/appeals teams are even more burdened with mission critical responsibilities, that affect not only the health of the hospitals but also the well-being of the community that could be affected by a hospital closing.

five aces dealt to CMS

CMS’ Hand After the FY2014 IPPS Final Rule is Published, As Proposed

Am I overstating the situation or overreacting? I don’t think so. And I’d bet you have the same feeling I do: you’re getting slammed by CMS, and you are at wits end to explain to upper management exactly what to expect, in the next 6 months alone — and I’m not even touching on ICD-10!

Again, I applaud the step you’ve taken to get out in front of all that, by getting your team trained, at the Boot Camp in July.





So even with your great move, recent events have added some new “wrinkles” — more like crevasses, actually — to the revenue cycle landscape. I’m talking about three new rulings by CMS, made in March and April:


Obviously, these are important rulings, and they will be covered, to some extent, at the Boot Camp.

But think about it…


Ok, I’m sure you’re not just sitting around waiting…

BUT…  (you heard that coming, right?)

shark infested waters

CMS is Dropping You Into Dangerous Waters, This Fall!

You really NEED to post a comment to CMS. So… what will you write?

And what happens if that 48-hour Benchmark for IP admission DOES go into effect, as it is now written in the Proposed Rule?

Wouldn’t it be great if you could hear what some of those experts have to say about all this BEFORE July?



So, let me tell a little about what I can do for you…

I’ve spent my career in several industries, but I’ve managed projects and teams responsible for anywhere from $10,000 to over $40 Million. Along the way I’ve learned not only how to get things done and get results, but I’ve also learned about how to not only feel better about myself and my job, even in difficult circumstances, but also how to make a difference, in both my job, my life and others’ lives.

That’s why I started Appeal Academy – I want to help you NOW, but I also want to make a difference, in the industry and in the lives of those around me. Now, here’s how I plan to do exactly that…


Because you have already registered for the Boot Camp, I salute your vision and expertise, and because of everything I mentioned above, I’m now offering you a very special, very important series of SIX webinars from Appeal Academy’s Center for Compliance:


part b inpatient rebill proposed rule

CMS Wants To Move the Inpatient Benchmark From 24 to 48 hours…

For Clarity?


Appeal Academy offers a series of webinars, featuring multiple experts. [modal id=”3509″ style=plain color=default size=default]Ernie de los Santos[/modal] is joined in these webinars by [modal id=”2839″ style=plain color=default size=default]Sharon Easterling[/modal] of Recovery Analytics, a well-known industry veteran with over 20 years of experience running coding, billing and denial/appeal teams, most recently overseeing the RAC Teams for a system of 32 hospitals.


Sharon and I interview four other experts, then go over what we would do with their advice, inside a hospital or hospital system. And finally, we answer the questions sent in over the whole series, by providers.

So here’s the lineup… the six webinars in this series… each one is 45-75 minutes long…
Hear from Dr. Steve Meyerson, a well-known expert and Physician Advisor from Accretive PAS, as we discuss several important factors to consider about what might need to change in the way your physicians write documentation for inpatient admissions, including what NOT to do! As usual, this is all real stuff with zero BS, and no sales pitches!
48-hour benchmark
Next, you hear from Day Egusquiza, ubiquitous HFMA speaker, President of AR Systems, and the busiest woman in healthcare. We caught up with her on the road and got her to talk about how she plans to NOW teach physicians, UR managers and Case Managers. Plus, she gives several important questions we ALL need to consider as we approach the time this rule might become Final.
48-hour benchmark
Over the past year, we’ve all seen or executed huge changes in appeals strategies — from changing the content of the appeals, or specifically asking for Part B as an alternative, to deciding to appeal many, many more denials, especially medical necessity denials for short-stay inpatient claims. These new rules seem to be CMS responding to the overwhelming number of appeals and the decisions by the ALJs and the DAB, so blatantly disagreeing with CMS’ own interpretations of their rulings. Now, in the face of these new rules, what needs to change, if anything? What tactics do you adopt? Does your strategy need to change? Hear the opinion of Steven Greenspan, an attorney with EHR, and possibly the most experienced lawyer in the land at dealing with ALJ hearings. Steven has plenty to say, and you need to hear it all.
48-hour benchmark
These new rulings have many, many changes in them, especially the IPPS Proposed Rule. But the change in the benchmark raised several questions that we decided to ask of an experienced law firm. We chose to talk to Jessica Gustafson, a founding partner of The Healthlaw Partners, a firm with wide experience and clientele, across the country. We asked Jessica to talk to us about the unusual use of the term “presumed” in the ruling, what are its implications for arguments; what is the potential legal implications for both providers and beneficiaries; what is the legal basis for CMS restricting the ALJ and DAB from calling for Part B payments; and what about the “timing” of care, and how that might be used by auditors now to deny inpatient claims and accuse hospitals of “gaming the system” as CMS so pointedly mentions in the ruling? This turned out to be the longest of our interviews, and is FULL of advice you NEED TO HEAR!
48-hour benchmark
We track down four working Physician Advisors, from around the country, who also happen to be speakers at the upcoming PA Boot Camp, and ask them about what they think of the new benchmark, and how they plan to deal with it, if it in fact becomes the final word in October. So, here’s your chance to hear from them BEFORE the Boot Camp, and even ask them your questions!
48-hour benchmark
During all these webinars, you and other providers have the opportunity to send us and the speakers your questions — it’s easy to do, or just send them to us directly at — be sure to tell us who the question is for!  Anyway, for this webinar, Sharon and I go over the questions we can answer or relay the answers we get back from all our speakers, plus any comments they may wish to make or offer for your edification. We’ll take the best of the bunch to answer here, but we will answer ALL the questions, at least by email.


Some of these are already available to attend, by the time you read this. All these will be broadcast well before the June 25 deadline for comments, so you can not only think about it all, but hear from veteran industry experts, and PLAN both your comments and how you will respond to this HUGE change, should it become part of the Final Rule that will become effective October 1, 2013.

PLUS – almost forgot to tell you about this part…


My system lets you choose the day and time you want to attend the webinar. All our webinars are available on multiple days, and multiple times each day. YOU PICK. YOUR SCHEDULE. And you can attend as many times as you like.

See one that you want to share with others at your campus? No problemo… Just register again, gather the others around the screen or in a room with a projector, BINGO – a working lunch meeting, with great information, from well-known experts, and NO EXTRA CHARGES. Cool, right?

So about now you’re wondering what all this costs, right?

The value of just these six webinars is easy to see, and I could be charging the typical rates you would normally pay in our industry, of $195 per webinar.

But Appeal Academy doesn’t do that — because I’m not like the rest of the industry…

If You Join

Simple as that.

No upsells, no add-ons, no extras to pay for. But you DO get more value EVERY MONTH as we keep adding exclusive webinars and articles for Academy Members.

Look at all the VALUE of a Membership:


Moving the Benchmark (6 webinars)………………………….$1,170.00 (6 x $195 value)

Overview: the 2014 RAC SOW (3 webinars)…………………..$ 585.00 (3 x $195 value)


Lecture Halls (36 webinars hourly)………………………….$7,020.00 (36 x $195 value)


The Frank Cohen Group Series: Practice Analytics………..$1,485.00 (15 x $99 value) ICD-10 Series……………………………………..$2,340.00 (12 x $195 value)

At least one more webinar added every month…………..$2,340.00 (12 x $195 value)


Now like I said before, I want to make a difference. I’m sure I could make a difference even if I just offered all those webinars for the typical pricing, just like everyone else. But then, I’m not everyone else.

I could offer you all that at 50% of the going rate, which would be $7,470 or $620/month.

Or even, 25% of the going rate would a good price, at $3,735 or $310/month.

But even those prices seem high to me, and my purpose is to help.

So… because I want to make a difference, and help providers like you fight off these unfair attacks on your bottom line, and because I know how to use technology to help you not only learn about compliance but also grow your own career, feel better about yourself and your job, I want to make it very easy and simple for you to get what you need.

Just so you know, my wife, my colleagues, my former employers all think I’m nuts to do it this way, but oh well. Like I said, I want to help, so I had to come up with a price that does that, right?

So…here’s all you will give to get all this value now, with immediate access:


Appeal Academy Members normally pay $250 for a full year of access, or just $29.95 monthly, with no contract.

Ridiculous, right? Well it gets better…

Because you already signed up for the PA Boot Camp, I’m offering you a special offer, for a limited time.


(Like I said, I’m out to make a difference…)



I can’t make this offer forever, though, and I want you to get to see all this material in time to plan and to make a comment to CMS, so there’s a time limit…

You have 72 hours to decide — and you can either use a credit card OR get an invoice to pay by check.

But here’s the timer, and this page WILL expire 72 hours from the time you first see it.



See you on the inside.

Ernie de los Santos

Founder of the Feast and Faculty Chair


To-Do for a To-Do

Is this YOU? Are you procrastinating???


Well, I haven’t told you yet about TWO MORE THINGS — First, is a BONUS for Boot Camp Registrants.


I’m offering YET ANOTHER webinar series, all about Project Management, including my popular presentation on what I call my “NO FEAR” Appeal Strategy.


You can see a short video of me talking about that strategy, from the 7th National RAC Summit Post-Conference, here. It’s free, and it’s only about 8 minutes long, so go see it!



But I’ll also be broadcasting a full webinar about that strategy, PLUS a complete series of eight webinars, all about project managment techniques that can be used by anyone, not just project managers, to introduce new ideas or change things, in any area or function.


Here’s a list of what’s included, to give you a better idea of what you’ll be getting:


  1. What IS This Project? – How to agree on a precise specification for the project – ‘Terms of Reference’
  2. How Do You Create The Project Plan? – Plan the time, team, activities, resources, financials – using suitable project management tools.
  3. Who Should I Talk To and When? – How to communicate the project plan to your project team – and to any other interested people and groups.
  4. How and What Do You Delegate? – How to agree on and delegate project actions.
  5. How Do I Manage and Motivate My Team? – How to inform, encourage, enable the project team.
  6. How Do I Keep the Project On Track? – Check, measure, monitor, review progress – adjust plans, and inform the team and others.
  7. What Do I Do When It’s Finished? – You’re NOT done! How to review and report on performance; how to give praise and thanks to your team.
  8. Where Do I Go From Here? – You’re STILL NOT DONE! Project follow-up – train, support, measure and report results and benefits.
So… there’s another NINE WEBINARS — another $1,755 of value (9 x $195 value) that you get as a FREE BONUS for taking advantage of this offer NOW.
(Now, in the interest of full disclosure, please know that these nine webinars are still under development,
at the time of this writing, but will begin to be posted in July, and are scheduled be finished by the end of August.)

Now I know what you’re thinking…don’t be overwhelmed by that list!  Remember you can watch or listen to these anytime! You can always pick and choose, and share them with your colleagues.

These are broken down into short, 20-30 minutes pieces, that can even be downloaded as MP3s, so you can even listen to them on your phone, in your car, at home, whatever.

All of these will be available BEFORE the PA Boot Camp, so you can come prepared, LOCKED & LOADED to learn the most from the Boot Camp, and go back to your own facility, ready to apply the “NO FEAR” Strategy to your hospital, your job, your life.

REMEMBER: You get ALL OF THIS for the one low price of $125…



One last thing: I believe in myself, my product, my expertise, my talents. I believe in them so much, that I’m willing to take ALL THE RISK.

I’ll take all the risk, within the first 60 days, by giving you an Iron-Clad, No Questions Asked, 100% Money Back Guarantee for your Membership. If you are not totally jazzed by what you get from me, if you’re not totally convinced this is the best money you’ve ever spent on this kind of help, then I’ll refund you ALL YOUR MONEY. You just send me an email or call me, I’m not hard to find, and I’ll refund your money right away.


Within 60 days, you will have gone to the PA Boot Camp, and seen not only what I can do, but what you can do with all THAT material, based on what I’ve taught you through Appeal Academy. If you think my material was not worth $125, then I’ll give it back to you, and everything you’ve received from me, is my gift to you. No questions asked.moneyback_800x390






See you on the inside!


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