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Editor's note: This is an excerpt from Michelle Ponte's June 22 column on what leaders can do now to prepare for the coming year.

This year's HFMA conference was especially important because many of the sessions covered issues hospitals are trying to understand better, such as RACs and tax-exempt status.

Here's a look at two of the more interesting topics and conversations that made it to the top of my list.

Estimate your tax bill now
There are still more questions than answers when it comes to knowing how to prepare your finances in the event of a loss of tax-exempt status. Provena Health's Gary Gasbarra, system vice president, chief accounting officer, and corporate controller, along with other panelists, discussed Provena Covenant Medical Center's loss of tax-exempt status and challenges that other hospitals face.

Of chief concern is that all nonprofit hospitals' tax-exempt status may go away if Sen. Charles Grassley (R-IA) and other legislators have their way once healthcare reform passes.

Panelists urged hospitals to be proactive and at least take the steps to estimate their property tax bill should their tax-exempt status be revoked. Panelists talked about roadblocks associated with finding someone who can help you assess the value of your real estate.

Another issue, says Gasbarra, is tax authorities' lack of understanding in whether they should be measuring gross or net revenues. Some states, he says, are measuring net.

Get RAC ready
"You are going to get a RAC audit, and it will be a three year look-back. You need systems in place today." That's the word from Elizabeth Lamkin, CEO of 93-bed Hilton Head Regional Hospital, who spoke to an audience that was eager to learn about her experiences as a RAC audit survivor. Lamkin said in preparing for an audit, organizations must first have the right physician advisor in place to handle medical necessity cases and this person must have a strong relationship with case managers. Panelist Rudy Braccili, senior director, national Medicare center for Conifer Health Solutions, also noted that appeals cost an average $3,000 to $7,000 to file, which is not reimbursed if you win. There are five opportunities to appeal and it takes five years to exhaust all levels of appeals, he said.

"Be sure to only appeal cases in which you have sound reason to appeal because you have to pay interest on payments." The highest dollar take-back is from medical necessity cases, he said.