Podcasts about doctorsmanagement

Do you ever feel afraid that your medical office is not compliant? In this latest episode, I speak with Mr. Sean Weiss-The Compliance Guy. We share: the most common mistakes physicians are making. why some practices are targeted by the Department of Justice or the Social Investigations Unit the modifier that raises a red flag AND the best resources to keep up to date. Luckily, there are three simple steps you can take starting today to help with medical chart compliance. --------- Sean M. Weiss Partner and Vice President of Compliance DoctorsManagement, LLC Sean has dedicated his career to serving and advocating on behalf of health care providers, hospital networks, and integrated health systems to ensure a level playing field and due process. Over the past 27-years Sean has focused on helping organizations achieve measurable financial results to ensure stability in their market all while significantly reducing the risk of non-compliance. Sean's knowledge of the inner workings of government agencies at both the state and federal level make him an invaluable asset to clients. Sean leads the strategic litigation defense and audit team for DoctorsManagement, LLC. Sean is engaged by the largest and most revered law firms in the nation on matters tied to the False Claims Act and Health Care Fraud Statute cases to ensure the best possible defense for clients targeted by government agencies, their contractors, and commercial payer special investigative units. Sean serves as a third-party Compliance Officer for numerous nationally recognized organizations across the country creating and ensuring a "Culture of Compliance" to mitigate risk and culpability. Sean is a published author and the host of The Compliance Guy Podcast, the intersection where Compliance and the Business of Medicine meet... bringing to life regulatory compliance and health law related issues, reaching tens of thousands of health care professionals weekly. A sought-after healthcare speaker, Sean has an engaging, no-nonsense style and has delivered keynote addresses for countless professional societies and healthcare organizations. In his educational sessions, Sean presents workable solutions to the latest issues surrounding healthcare compliance, medical auditing, and practice and revenue cycle management. In May of 2021 Sean created The Compliance Guy Podcast©, bringing industry experts in the areas of operations, clinical, and legal together to ensure the highest-level of learning and guidance to healthcare professionals. Sean serves on boards of directors for both for-profit and non-profit organizations. He is a published author and a contributing author, and his written voice has reached tens of thousands of readers. His contributions to print and online publications (JAMA, Medical Economics, Part B News, BC Advantage, The Coding Edge, and MGMA Connections) cover a wide range of healthcare topics. ---------------

Do you ever feel afraid that your medical office is not compliant? In this latest episode, I speak with Mr. Sean Weiss-The Compliance Guy. We share: the most common mistakes physicians are making. why some practices are targeted by the Department of Justice or the Social Investigations Unit the modifier that raises a red flag AND the best resources to keep up to date. Luckily, there are three simple steps you can take starting today to help with medical chart compliance. --------- Sean M. Weiss Partner and Vice President of Compliance DoctorsManagement, LLC Sean has dedicated his career to serving and advocating on behalf of health care providers, hospital networks, and integrated health systems to ensure a level playing field and due process. Over the past 27-years Sean has focused on helping organizations achieve measurable financial results to ensure stability in their market all while significantly reducing the risk of non-compliance. Sean's knowledge of the inner workings of government agencies at both the state and federal level make him an invaluable asset to clients. Sean leads the strategic litigation defense and audit team for DoctorsManagement, LLC. Sean is engaged by the largest and most revered law firms in the nation on matters tied to the False Claims Act and Health Care Fraud Statute cases to ensure the best possible defense for clients targeted by government agencies, their contractors, and commercial payer special investigative units. Sean serves as a third-party Compliance Officer for numerous nationally recognized organizations across the country creating and ensuring a "Culture of Compliance" to mitigate risk and culpability. Sean is a published author and the host of The Compliance Guy Podcast, the intersection where Compliance and the Business of Medicine meet... bringing to life regulatory compliance and health law related issues, reaching tens of thousands of health care professionals weekly. A sought-after healthcare speaker, Sean has an engaging, no-nonsense style and has delivered keynote addresses for countless professional societies and healthcare organizations. In his educational sessions, Sean presents workable solutions to the latest issues surrounding healthcare compliance, medical auditing, and practice and revenue cycle management. In May of 2021 Sean created The Compliance Guy Podcast©, bringing industry experts in the areas of operations, clinical, and legal together to ensure the highest-level of learning and guidance to healthcare professionals. Sean serves on boards of directors for both for-profit and non-profit organizations. He is a published author and a contributing author, and his written voice has reached tens of thousands of readers. His contributions to print and online publications (JAMA, Medical Economics, Part B News, BC Advantage, The Coding Edge, and MGMA Connections) cover a wide range of healthcare topics. ---------------

Sean sat down with Scott Kraft, Senior Compliance Auditor for DoctorsManagement, LLC to discuss strategic defense litigation services and how those played a key role in the outcome of the United States v. Rajendra Bothra, et. al case on June 28th, 2022! Here are some of the headlines in what is one of the Nation's largest heath care fraud cases. "How 4 doctors beat the feds in botched $500 million pill mill case" (https://www.freep.com/story/news/local/michigan/macomb/2022/06/30/doctors-opioid-scheme-birmingham-bothra/7778004001/) United States v. Bothra: (https://casetext.com/case/united-states-v-bothra-1) "Michigan Physician Rajendra Bothra Acquitted in Prescription Drug Fraud Case After More Than 3 Years in Prison" (https://americankahani.com/community/michigan-physician-rajendra-bothra-acquitted-in-prescription-drug-fraud-case-after-more-than-3-years-in-prison/) "4 Michigan doctors acquitted of charges in prescription drug scheme" (https://www.clickondetroit.com/news/2022/06/29/4-michigan-doctors-acquitted-of-charges-in-prescription-drug-scheme/)

Sean sits down with Frank Cohen, Director of Analytics and Business Intelligence for DoctorsManagement, LLC Such an outstanding discussion on statistical sampling and post audit extrapolation! Spend some time with us to learn and better understand how to create a process from the start to avoid fatal flaws resulting in bigger problems and how to effectively challenge payers when they fail to follow statistical standards!Frank Cohen's areas of expertise include data mining, applied statistics, and predictive analytics. In addition, he provides compliance risk analysis and meaningful assistance to healthcare organizations in the areas of process improvement, compliance, quality and profitability.Frank works with a wide range of clients including solo-physician offices to practices with over 1,000 physicians, academic medical centers, cancer clinics, legal and accounting professionals, government agencies, and national associations such as MGMA and AMA. He and his team have worked with physicians and practices in nearly 60 different specialties and within every state in the U.S.The author of several books, including his newest, “Don't Do Something, Just Stand There: A Primer for Evidence-Based Practice,” Frank is a sought-after speaker. He has participated in and published numerous articles and studies and trained thousands of physicians, administrators, CPAs and other healthcare professionals in all areas of healthcare analytics.His experience also includes eight years as a physician assistant in both the Navy and as a civilian, clinic administrator and hospital CEO. Frank's clients appreciate his depth of knowledge and especially his ability to deliver complex analytical findings

What an awesome panel discussion with Scott Kraft, Stephanie Allard, and Paul Spencer of DoctorsManagement! Show topics included: 1. CIGNA Policy Change on Modifier 25 (EM Services with Separate Service/Procedure on same date) 2. Urine Drug Testing - Screening vs. Definitive, when can a provider go straight to definitive testing, medical necessity, and the laboratory's responsibility 3. Coming out of the Pandemic and the biggest Audit Targets (Testing, EM Services, Telehealth, etc.) Such a brilliant discussion with an outstanding panel!

In the conclusion of Matthew's conversation with Sean Weiss AKA “The Compliance Guy”, the Vice President of Compliance at DoctorsManagement, Sean talks about what it takes to be compliant today and what he would do to fix the healthcare industry.

Matthew welcomes Sean Weiss AKA “The Compliance Guy” to the podcast. Sean is a Partner and Vice President of Compliance at DoctorsManagement. Over his 25-year career, Sean has helped healthcare facilities find workable solutions to issues surrounding healthcare compliance, medical auditing, and practice and revenue cycle management. In part one, Sean shares how he became “The Compliance Guy”, how DoctorsManagement assists over 60,000 physicians across the country, and why he believes the healthcare industry is overregulated.

The National Institutes of Health (NIH) is awarding $470 million to New York University to perform a national study on “tens of thousands of people, to research the long-term effects of COVID-19.”One such individual who might be included in the study will be the special guest during the next live edition of Talk-Ten-Tuesdays: Deborah Grider, longtime ICD10monitor national correspondent and senior healthcare consultant for Karen Zupko & Associates. Grider will return to the broadcast with an update on her status as a “long hauler,” having contracted the deadly coronavirus more than a year ago.The live broadcast will also feature these other segments:The Coding Report: Laurie Johnson will report on the outcome of last week's Coordination and Maintenance Committee.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.2021 E&M Update: It's about time: Nearly everyone thought that time reporting for evaluation and management (E&M) services would be eased through the American Medical Association (AMA) 2021 guidelines. Yet there are controversial areas and discrepancies in interpretation of the published guidance, according to Shannon DeConda, who will report on those issues. DeConda is the founder of the National Alliance of Medical Auditing Specialists (NAMAS) and a partner of DoctorsManagement.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.Town Hall: Your questions will be answered live during this special interactive broadcast.

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Can you believe it's almost the 1-year anniversary of this podcast series?! Season 3 is almost over, and Sonal's 16th episode of the season features Partner, Vice President, and Chief Compliance Officer of DoctorsManagement and Newsworthy special guest, Sean Weiss. Trusty Tip features Sonal's compliance recommendations for the Targeted Probe and Educate (TPE) Program that has ramped back up. Spark inspires us all to reflect on our journeys based on the inspirational words of Pope Francis. Go ahead and listen, subscribe, rate and review! Find Sean Weiss on various social media platforms at: https://www.linkedin.com/in/seanmweissakathecomplianceguy/ https://www.doctors-management.com/ https://thecomplianceguy.com/ sweiss@drsmgmt.com Paint The Medical Picture Podcast now on: Anchor: http://anchor.fm/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Sonal on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn at: www.linkedin.com/in/sonapate Find Sonal on her website: http://paintthemedicalpicturepodcast.com If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/sonal-patel5/message Support this podcast: https://anchor.fm/sonal-patel5/support

Are your physicians providing detailed documentation as they adhere the 2021 Evaluation and Management (E&M) Guidelines? Frank Cohen, senior healthcare analyst and director of business intelligence for DoctorsManagement, is concerned that they might not be – which, he believes, squarely puts them in an uphill battle, defending themselves from quality audits and potential malpractice suits. And Cohen has the numbers to back up his concerns, which he will share during the next live edition of Monitor Mondays.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment. RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that's occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.

“Incoming!” are the typical dreaded shouts heard from soliders hunkered down in bunkers when shelling begins.Today, across America, you can hear the same cries when it comes to claims auditing. Audits are incoming. Third-party auditors, governmental auditors, even auditors from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) looking at COVID-related claims are incoming – and the onslaught is occurring in rural hospitals as well as big city health systems and teaching facilities alike.Does this portend a future of escalating audits? During the next live edition of Monitor Mondays, an all-star lineup of audit and regulatory experts will come together in a 60-minute edition of the venerable weekly broadcast.The live broadcast includes the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will make his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.The Court Report: Famed whistleblower Mary Inman, a partner in the London office of Constantine Cannon, will report on three notable whistleblower suits, all involving well-known healthcare brands.The Analysis: E&M 2021 Guidelines: Senior healthcare analyst Frank Cohen, director of business intelligence for DoctorsManagement, will report on his latest analysis of evaluation and management (E&M) 2021 guidelines for office visits; noteworthy will be his analysis of medical necessity audits.Utilization Management versus Utilization Review: Dr. John Zelem, founder of Streamline Consulting Services, will return to the broadcast to explain why utilization management and utilization review are not to be used interchangeably, yet they are, with increased frequency.Jab City, USA: Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Warren Alpert Medical School of Brown University, and an authority on the coronavirus will return to the broadcast to report on vaccine rates in the U.S. – as most experts warn that herd immunity is not likely to be achieved in the near future.Law and Order: Monitor Mondays’ own physician and attorney, Dr. John K. Hall, will report on the 11th Circuit Court of Appeals decision in the American College of Emergency Medicine versus Blue Cross and Blue Shield of Georgia. Understanding and applying the court's decision will help you and your team when faced with denials for services provided in your emergency department.

What percentage of administrative law judge (ALJ) decisions end up at the Medicare Appeals Council? What percentage of those decisions are reversed?These are important questions asked by a reader in response to a recent article written for RACmonitor by Frank Cohen, senior healthcare analyst and director of business intelligence for DoctorsManagement. Cohen, who has extensive experience as a subject matter expert in ALJ hearings, will look under the hood of the perpetual appeals machine, while sharing insight into the appeal process – describing how it is broken and why.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers. Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.

With little in the way of reporting on the backlog of appeals at the Administrative Law Judge (ALJ) level, you could conclude that such hearings are on hiatus.But that’s not the case, according to senior healthcare consultant Frank Cohen, who will be reporting the lead story during the next live edition of Monitor Mondays. Cohen, director of business intelligence at DoctorsManagement, is expected to report that while he had testified at four ALJ hearings in all of 2019-2020, he has already testified at four so far this year, with four more between now and June – all pertaining to cases from 2014-2015. Ask Cohen why the Recovery Audit Contractors (RACs) are to blame for the backlog – his answer will be one you may not expect.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.Monday Rounds: Attorney and physician John K. Hall, MD, founder of the Aegis Firm, will be pinch-hitting for Ronald Hirsch, MD, who regularly makes his rounds on Monitor Mondays.

The Centers for Medicare & Medicaid Services (CMS) 2021 Final Rule and 2021 Medicare Physician Fee Schedule (MPFS) are effective Jan. 1, 2021, and both affect reimbursement.But in a rare move, CMS increased the conversion factor (CF) in the MPFS twice in one week as a result of the COVID-19 relief bill, which added a hike of 3.75 percent.For an update on the major CMS changes for 2021 that will affect your reimbursement under the Part B Physician Fee Schedule, tune in to the next live edition of Talk Ten Tuesdays, coming your way Tuesday, Jan. 12 from 10-10:30 a.m. EST. That’s when nationally recognized professional coder and auditor Terry Fletcher will join the broadcast to report on all the relevant details.The live broadcast will also feature these other segments:RegWatch: Stanley Nachimson, former CMS career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington, D.C.SOAP Note: Shannon DeConda, founder of the National Alliance of Medical Auditing Specialists and a partner of DoctorsManagement, will provide a long-awaited update to the legendary SOAP (subjective, objective, assessment, and plan) note.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.The Coding Report: Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC, will report on the latest ICD-10 codes.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk-Ten-Tuesdays co-host, will report on another thought-provoking topic that has captured her attention.

Providers that received payments from the federal Provider Relief Fund will be required to file reports demonstrating their compliance with the terms and conditions of those payments.Reporting on this, our lead story during the next live edition of Monitor Mondays, will be healthcare attorney Andrew Wachler, managing partner of Wachler & Associates. Mr. Wachler will report on anticipated “hot spots” in the auditing of the use of these payments, including healthcare-related costs and lost revenue attributable to the coronavirus and expenses that have been reimbursed from other sources.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Audit Report: Sean M. Weiss of DoctorsManagement will return to the broadcast with an update on comparative billing reports (CBRs), reporting that providers need to change their billing patterns to avoid financial losses.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen will also conduct the Monitor Mondays Listeners Survey.

More payment cuts are being proposed by the Centers for Medicare & Medicaid Services (CMS) for next year, a move sure to impact the many hospitals participating in the 340B drug discount program, as described in the 2021 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule.Such proposed cuts are expected to reduce Medicare Part B drug payments to levels lower than in 2018, when the last round of cuts were made. Reporting our lead story during the next edition of Monitor Mondays will be Maureen Testoni, CEO for 340B Health. Also participating in the broadcast will be ICD10monitor national correspondent Timothy Powell, CPA, who will report on the expected financial impact of those proposed cuts to critical access hospitals (CAHs).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Special Report: Even though length of stay (LOS) continues to generate buzz, there might be an alternative to the long-heralded metric. John Zelem, board-certified-surgeon-turned healthcare consultant, will report on another set of criteria that could be gaining traction. Audit Report: Sean M. Weiss of DoctorsManagement will return to the broadcast with an update on the increase in auditing activity by federal contractors.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.IFR Report: Angela Phillips, PT, president and chief executive officer for Image and Associates, considered by many to be one of the nation’s foremost authorities on inpatient rehabilitation facility compliance, returns to the broadcast to report on how the issue of “medical necessity” for IFR stays is prompting concerns about audits and denials. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications that have the potential to put providers at risk.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Battle lines in a budding court battle could be drawn soon.A federal appeals court has reversed the decision of a lower court and upheld the action by the U.S. Department of Health and Human Services (HHS) to pay formerly grandfathered off-campus outpatient departments run by hospitals at the same, lower rate of physician clinics.Experts believe that could mean a potential loss of $800 million to these already struggling hospitals, the finances of which have been especially hit hard during the COVD-19 pandemic. There is clearly a legal battle ahead. Reporting our lead story during the next edition of Talk Ten Tuesdays will be nationally recognized professional coder and auditor Terry Fletcher.The live broadcast will also feature these other segments:Tuesday Focus: Shannon DeConda, founder of the National Alliance of Medical Auditing Specialists and a partner of DoctorsManagement, will continue her series for ICD10monitor and Talk Ten Tuesdays in which she delves into the massive changes in the new American Medical Association (AMA) evaluation and management (E&M) documentation guidelines for 2021: changes that become effective Jan. 1, 2021.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk-Ten-Tuesdays News Desk.The Coding Report: Winners and losers. Which proposed ICD-10 codes will become adopted, and which ones will fail? Linda Holtzman, founder of Clarity Coding and an avid follower of the CMS Coordination and Maintenance Committee, will handicap last week’s meeting.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will report on another thought-provoking topic that has captured her attention.

The recent announcement by the Centers for Medicare & Medicaid Services (CMS) that it will be “ramping up” audits are quickly becoming a reality for providers across the country. Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Unified Program Integrity Contractor (UPIC) auditors are going full steam ahead, using data and analytics to assess overpayments via automated reviews – and new language in UPIC letters paints an ominous picture for providers they deem non-compliant.Reporting the lead story during this edition of Monitor Mondays is Sean M. Weiss of DoctorsManagement, who addresses these issues and the steps necessary to ensure a level playing field.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen also conducts the Monitor Mondays Listeners Survey.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) started rolling out post-payment audits again, as of Aug. 3, but now – after finding inconsistencies in the accuracy of some COVID-19 tests, and considering the fact that CMS has been paying an additional 20 percent to providers and facilities “treating patients with COVID or testing for COVID” – the agency has enacted a new mandate to qualify for the increased reimbursement. During the next live edition of Talk Ten Tuesdays, Terry Fletcher, a nationally recognized professional coder and auditor, reports on the controversy surrounding our lead story.The podcast also features these other segments:RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, reports on the latest regulatory news coming out of Washington, D.C.Tuesday Focus: 2021 E&M Guideline Changes: Grant Huang, a consultant and auditor for DoctorsManagement, will filling in for Shannon DeConda in her ongoing series about the significant changes in the 2021 E&M guidelines.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.The Coding Report: Cari Greenwood, an independent coding consultant, reports on a current healthcare coding issue that has national importance. TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on another thought-provoking topic that has captured her attention.

The omnipresent coronavirus pandemic continues to upend lives, from mundane occasions like grocery shopping to long-planned space exploration missions. The pandemic is manifesting itself from the halls of Congress to the cubicles at Centers for Medicare & Medicaid Services (CMS) headquarters, to classrooms, theatres, homes, and places of worship, among other venues.On the next live edition of Monitor Mondays, we will explore the impact of the coronavirus on audits and auditing, proposed rules, guidance, and waivers.Joining the broadcast to report on anticipated pandemic-related audits will be Dr. John K. Hall, founder of The Aegis Firm, a healthcare consulting firm. Dr. Hall, also an attorney, will discuss these types of scenarios, and how to prepare for the inevitable denials coming your way.Also during the 60-minute broadcast, you’ll hear from Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University, who will provide a much-needed perspective on the impact of the prolonged epidemic. And making her debut appearance on Monitor Mondays will be Julia K. Brodt, PhD, an educator and former epidemiologst, who will provide a layperson’s background on antibodies, which are fundamental in the quest for a vaccine.Other segments to be featured during the podcast include:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Audit Report: Sean Weiss, compliance officer for DoctorsManagement, returns to the broadcast with the Monitor Mondays Audit Report.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.IRF Report: Angela Phillips, PT, president and chief executive officer for Image and Associates, reports on the the CMS final rule for the inpatient rehabilitation facility (IFR) prospective payment system for the 2021 fiscal year.

While the battle cry of “defund the police” has emerged from Black Lives Matter activists following the death of George Floyd at the hands of Minneapolis police, could there also be sufficient reason for providers to advocate to “defund the Unified Program Integrity Contractors (UPICs)?”According to RACmonitor investivative reporter Ed Roche, UPIC auditors are attacking osteopathic medicine, and might need lessons in reading patient notes. During the next live edition of Monitor Mondays, Roche will explore the seeming incompetence of auditors when they go after such providers. Osteopathic doctors help manage pain, but there may be no cure for an incompetent audit.Other segments to be featured during the live broadcast include the following:COVID-19 Report: Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University, will provide an update on the pandemic that claimed the lives of more that 152,000 in the U.S.Audit Report: Sean Weiss, compliance officer for DoctorsManagement, will report on the latest wrinkle in the ongoing kerfuffle of telehealth and patient consent.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

One day she’s consulting in Los Angeles. The next day she’s back in Indiana, with upcoming client calls scheduled at hospitals and physician practices in nearly every U.S. city and small town. Her frequent flyer miles would qualify for a round-trip to Mars.High-flying and always in demand as a speaker, Deborah Grider came crashing down, diagnosed with COVID-19 earlier this year. She’s recovering now – enough so that she wrote a personal account of her COVID ordeal for ICD10monitor. Grider will report on coding sequelae of COVID-19. The podcast also feature these other segments:CDI, Past, Present, and Future: The Series: Nationally recognized clinical documentation integrity (CDI) expert Cheryl Ericson, clinical program manager for Iodine Software, launches an exclusive new series for ICD10monitor and Talk Ten Tuesdays that traces the evolution of CDI, noting that although the practice has evolved, the metrics haven’t.The Coding Report: Laurie Johnson reports on the coding news that’s in the nation’s spotlight.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.E&M 2021: Shannon DeConda, founder of the National Alliance of Medical Auditing Specialists and a partner of DoctorsManagement, begins a new series for ICD10monitor and Talk Ten Tuesdays in which she delves into the massive changes in the new American Medical Association (AMA) evaluation and management (E&M) documentation guidelines for 2021: changes that become effective just four short months from now.

Two major storylines are discussed during this edition of Monitor Mondays, with the exclusive 60-minute broadcast to focus on the raging coronavirus pandemic and the imminent auditing of Medicare and Medicaid claims scheduled to begin Aug. 3, as directed by the Centers for Medicare & Medicaid Services (CMS).Joining the broadcast to report on the coronavirus will be Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University. Offering an update on the imminent audits of Medicare and Medicaid claims will be healthcare attorney Andrew Wachler, managing partner of Wachler and Associates. And Sean Weiss, chief compliance officer for DoctorsManagement, reports on the issues and implications associated with the public health emergency (PHE), which was extended recently by Alex Azar, Secretary of the U.S. Department of Health and Human Services (HHS).Two reports from two provider organizations will round out the Monitor Mondays coverage of the impact of the deadly coronavirus on hospitals. Dennis Jones, administrator of patient financial services at Montefiore Nyack Hospital in Nyack, N.Y., once near the epicenter of the virus, reports on how his facility has emerged from the worst of the spike in the northeast. And Nicole Thorell, chief nursing officer at Lexington Regional Health Center, reports on how her rural hospital has managed to survive during the pandemic.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment. reporting on legal implications during the pandemic. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during this live broadcast to answer your questions.

Waivers from regulations, dire shortages of ICU beds, and scarce personal protective equipment (PPE), including gloves, gowns, and masks, are all part of the new normal as the coronavirus (COVID-19) continues to generate global headlines, especially in the United States.Amid a cacophony of misinformation, providers and patients are searching for clarity in this fog of war. That time has come. Next Monday, the long-running and authoritive voice of healthcare regulation, Monitor Mondays, will broadcast a live, 60-minute town hall, during which its panelists will answer your questions and those of your colleagues.The broadcast rundown will include updates from the following, and then segue to the town hall. Participating in the special news update will be the following:Rural Health Crisis: The global pandemic that is the coronavirus is spreading to the wide-open spaces of rural America, threatening the very existence of hospitals, caregivers, and patients. Reporting on this crisis will be the vice president of government affairs and policy for the National Association of Rural Health, Brock Slabach.RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report. Emanuel is expected to report on auditing activities by third-party auditors during COVID-19.Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, will report on contingency planning during the pandemic.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on how hospitals should respond to the homeless population presenting in emergency departments during the COVID-19 crisis. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the $2 trillion COVID-19 economic stimulus deal passed by the Senate on Wednesday and expected to be voted on by the House on Friday.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers during the global pandemic, which has now resulted in more than 1,000 U.S, deaths.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Seldom does a week pass without news about a pharmaceutical giant engaged in corporate wrongdoing. This week, the feds announced that they had filed a complaint under the False Claims Act (FCA) against Mallinckrodt ARD LLC. The complaint alleges that the pharmaceutical company “avoided paying hundreds of millions of dollars in Medicaid rebates due to significant drug price increases” as a result of “large increases in the price” of its drug H.P. Acthar Gel.Recently, pharmaceutical company Sanofi-Aventis U.S., LLC, agreed to pay $11.85 million to resolve allegations that it violated the False Claims Act by paying kickbacks to Medicare patients through a purportedly independent charitable foundation, The Assistance Fund. And earlier, as reported by RACmonitor, electronic health records provider Practice Fusion Inc. agreed to pay a total of $145 million to resolve criminal charges and civil claims that it solicited and accepted unlawful kickbacks from pharmaceutical companies.During this edition of Monitor Mondays, famed whistleblower attorney Mary Inman continues her reporting on the misdeeds of big pharma, with an update on the aforementioned Sanofi-Aventis FCA case.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, files the Monitor Mondays RAC Report.Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports on the next audits you can expect to encounter.Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis reports on current healthcare legislation – proposed, pending, or passed, and its intended consequences.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD makes his Monday Rounds with another installment of his popular segment.

The Trump Administration has grand plans to make healthcare prices more transparent, hoping a little bit of light will help lower the high costs of U.S. healthcare.In new regulations, the administration is requiring hospitals to disclose, for the first time, the prices they negotiated with health insurers for a wide range of services, as well as the prices they charge patients who are paying with their own money.But is it going to make any difference? We ask nationally-recognized professional physician coder and auditor Terry Fletcher to check with some health policy experts for their opinions about the new price transparency regimes. Terry gives you the best and worst-case scenarios, as well as the more realistic predictions, as this new rule is enforced during 2020. The podcast also features other segments:Tuesday Focus: Is it extravasation or infiltration? Knowing the difference is important for coders – and, actually, all healthcare professionals. Susan Gatehouse, founder and CEO of Axea Solutions, explains why this really matters.The Coding Report: Laurie Johnson has an update on the deadly coronavirus that continues to dominate international as well as domestic news headlines. She also reports on the upcoming Coordination and Maintenance Committee scheduled for March 17 and 18 at the headquarters of the Centers for Medicare & Medicaid Services (CMS).News Desk: Grant Huang, CPMA, CPC, a consultant for DoctorsManagement, anchors the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on another thought-provoking topic that has captured her attention.

Like a destructive earthquake, recent news from The Chartis Center for Rural, documenting the accelerated rate of closures among rural hospitals, is sending shock waves through rural communities.As with the Richter scale, the closure of one rural hospital is likely to have an exponential impact on all rural health. And the stark reality is that, as of January 2020, a total of 120 rural health facilities have closed their doors.Leslie Marsh, the chief executive of Lexington Regional Health Center in Lincoln, Neb., returns to Monitor Mondays and reports on precipitous peril for rural hospitals, which is now rising to a national disaster.Other segments featured on the podcast are:RAC Report: Senior healthcare analyst Frank Cohen returns to the broadcast to report on why Recovery Audit Contractors (RACs) can’t be considered unbiased in a court of law.Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports Artificial Intelligence (AI) and its impact on compliance and auditing.Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrickson & Bryon, will join the broadcast with his trademark segment Risky Business.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

With a 30,000-foot view of rural healthcare policies and regulations emanating from Washington, D.C., Leslie Marsh still recognizes the importance of having boots on the ground, serving as the chief executive of Lexington Regional Health Center in Lincoln, Neb.Marsh, who also serves as vice president of board of directors for the ruralMED Health Network, addresses the ubiquitous Z codes and their impact on the rural population, among other serious issues facing rural healthcare providers, during this edition of Monitor Mondays.Other segments to be featured during the podcast includes:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports the latest on Target Probe Educate.SDoH Report: Ellen Fink-Samnick has the latest news on rural health and also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser has his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The artificial intelligence (AI) arms race is heating up. The use of AI by healthcare providers responding to a wave of audits initiated by AI systems is an escalation. As the government continues to deploy AI systems in Medicare audits, providers will respond with their own counter-measures, also using AI. Reporting our lead story during the next edition of Monitor Mondays will be RACmonitor investigative reporter Edward Roche, who continues to monitor the intensifying showdown. Other segments to be featured on the podcast include:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

What once appeared to be a legislative slam dunk is now mired in controversy, this time fueled by the recently formed coalition dead-set against the proposed use benchmark payments.The Coalition Against Rate-Setting considers the practice tantamount to price-fixing. What will happen next to the compromise legislation, which was hammered out with bipartisan congressional support? Matthew Albright, chief legislative affairs officer for Zelis, reports our lead story during this edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group. Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter. Weiss joins the broadcast as a regular panelist, reporting on the ever-changing audit landscape.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

AmerisourceBergen, one of the nation’s largest pharmaceutical wholesalers, must turn over records to pension fund shareholders probing to determine wrongdoing by the drug distributor’s board for the company’s multi-billion-dollar legal exposure from the nationwide opioid crisis.AmerisourceBergen was already facing two congressional investigations, plus a Drug Enforcement Administration (DEA) probe. Reporting on this developing story is famed whistleblower attorney Mary Inman, a partner in the London law office of Constantine Cannon.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick has the latest news on a report from NPR about life experience and income inequality in the USA. Ellen will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment where he will discuss the new Important Message from Medicare.

It’s been a rough year for home health and hospice providers, especially in light of the fact that the Centers for Medicare & Medicaid Services (CMS) included a reduction in the base payment rate of 8.01 percent in the Patient-Driven Groupings Model (PDGM) of the 2020 Home Health Prospective Payment System Rate Update.Returning to Monitor Mondays is William Dombi, president of the National Association for Home Care and Hospice, who will provide a regulatory update for his association as its members prepare for another year of audits.Other segments to be featured on the broadcast include the following:Monday Focus: What are likely to be three major audit issues in 2020? Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reveals his pick of the top challenges you and your team will face in 2020.RAC Report: Healthcare attorney Knicole Emanuel reports on the latest activities by the Recovery Audit Contractors (RACs) and other third-party Medicare claims auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, unveils his 2019 Hirsch’s Heroes: individuals who, in his judgment, made outstanding contributions in the world of healthcare over the last year.

A federal court on Tuesday found that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced payments for hospital outpatient services delivered outside of hospitals in outpatient provider-based settings. The Centers for Medicare & Medicaid Services (CMS) could appeal the court’s decision on its site-neutral payment rule for hospital outpatient services. Score one for hospitals, but the war is far from over.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.E&M Coding Changes: Impending evaluation and management (E&M) changes for 2021 and their impact on coding and compliance professionals is reported by Shannon DeConda, founder and president of NAMAS.Monday Focus: Ransomware: Healthcare news has been rife with stories of bad actors from overseas planting ransomware in the business systems of hospitals and medical practices large and small. Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, reports on this ongoing problem and offers advice providers can take to mitigate the risk of global hackers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

A federal judge has upheld a lower court’s ruling that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced the 2018 Medicare reimbursement rate for drugs covered by the federal 340B Program. U.S. District Court Judge Rudolph Contreras, sitting in the District of Columbia, issued the ruling recently in the matter of American Hospital Association v. Alex M. Azar, HHS Secretary, ordering HHS back to the drawing board and warning it to act with haste to make a correction. Reporting our lead story during this edition of Monitor Mondays is RACmonitor national correspondent Timothy Powell. Other segments to appear on the broadcast include:Court Report: Two more pharmaceutical companies have agreed to pay $125 million to resolve allegations that they paid kickbacks through co-pay assistance foundations. Famed whistleblower attorney Mary Inman has an update on this story, which she first reported on April 15. Inman is a partner in the London office of Constantine Cannon. Monday Focus: What are the issues when trying to project the results of an audit to a larger population of providers? Senior healthcare analyst Frank Cohen with DoctorsManagement reports on the myth surrounding pass/fail rates for providers. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Link for Davids segment: The new guidance about co-location of space in hospital-based space, New DOJ guidance about Cooperation in False Claims Act CasesMonday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment. Links for Dr. Hirsch's segment: PREOPERATIVE MEDICAL TESTING BEFORE CATARACT SURGERY, Reduce Low-Value Preoperative Care

The Centers for Medicare & Medicaid Services (CMS) is inviting state Medicaid directors to partner with them to test new approaches to better serve those who are dually eligible for Medicare and Medicaid.More than $300 billion is spent annually by CMS and states to care for the dual-eligibles, and many of the 12 million of those beneficiaries have multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. Could the CMS initiative suggest cost-cutting, administrative burden reductions, or true innovation? RACmonitor national correspondent J. Paul Spencer, a senior health consultant for DoctorsManagement, reports our lead story during this edition of the long-running Monitor Mondays live broadcast.Other segments to appear on the broadcast include:Court Report: Famed whistleblower attorney Mary Inman reports on the guilty verdict handed down Thursday by a federal grand jury in Boston that found Insys Therapeutics founder John Kapoor and four other executives guilty of criminal racketeering in bribing physicians to prescribe powerful opioids to patients who didn’t need them. Inman is a partner in the London office of Constantine Cannon.2020 IPPS Proposed Rule: Social determinants of health (SdoH) are back in the news, since CMS is proposing to make homelessness a CC (complication and comorbidity) for the purposes of Inpatient Prospective Payment System (IPPS) coding. Does the CMS action signal that SDoH are a growing concern in the nation’s healthcare landscape? Continuing our reporting on this hot topic is nationally recognized SDoH authority and author Ellen Fink-Samnick.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, will report on all the latest hot topics and will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

In the final installment of a two-part series on prescription drug prices, during this edition of Monitor Mondays we will report on the latest initiative on a new “war on drugs” – the anticipated rollout by the Health Resources and Services Administration (HRSA) of a new secure website that hospitals, clinics, and health centers can use to see what price they should be paying for any drug covered under the 340B federal drug program. Reporting on this development will be Maureen Testoni, Esq., president and CEO for 340B Health. Other segments to appear on the broadcast include:Monday Focus: J. Paul Spencer, senior healthcare consultant for DoctorsManagement and a RACmonitor national correspondent, reports on the latest update to the American Medical Association’s (AMA’s) 2021 evaluation and management (E&M) changes. https://www.racmonitor.com/an-overview-of-ama-s-e-m-revisions-for-2021/Whistleblower Report: MedStar Health of Maryland has agreed to pay the government 35-million dollars to resolve allegations of under the False Claims Act that it paid kickbacks to a cardiology group. Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, has the latest news on this major story. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and conducts the Monitor Mondays Listener Survey. Click to view SNF Prospective Payment PDFRisky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. Monday Rounds: Howard A. Stein, DO, associate director of medical affairs for Centrastate Medical Center, makes his Monday rounds in the absence of Ronald Hirsch, MD.

Reaction to the reporting here on forensic audits continues to reverberate. During last week's Monitor Mondays broadcast, Amanda Gilliland, a revenue integrity nurse auditor at UW Health in Madison, Wisc., reported on her experience and efforts to appeal what she describes as "spurious" denials. As reported last Monday, these denials are for commonly billed services and items such as IV solutions, supplies, point-of-care (POC) labs, venipuncture, respiratory therapy services, etc.Michael Lewis, president of Financial Review Services of Houston, Tex. continues our reporting on this topic during this episode.The episode rundown also includes:Monday Focus: Analytics: Apropos of the lead story on forensic audits, senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, returns to the broadcast to report on the use of analytics to determine outliers.The Roche Report: RACmonitor investigative reporter and New York attorney Edward Roche returns to the broadcast with another one of his intriguing reports on an under-reported healthcare issue.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment. Dr. Hirsch also reports on how to bill for inpatient services when there is no admission order.Monitor with us™

During this edition of Monitor Mondays, nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, reports on the expected dismissal of the $188.1 million False Claims Act lawsuit filed by Med Analytics, LLC against Providence Health, now Providence St. Joseph, for allegedly upcoding various diagnoses. According to news reports, the United States declined to intervene in the case, and the allegations are likely to be dropped on Jan. 14, 2019.The broadcast rundown also will include:Monday Focus: Lawmakers in Michigan have approved permanent medical marijuana licensing rules, including a provision to allow dispensaries to deliver the drug to cardholders' homes. RACmonitor investigative reporter and New York attorney Edward Roche will report on the adoption of cannabis therapy in Medicare.The Audit Report: Becky Charlton, RN, denials/appeals coordinator at Blessing Hospital in Quincy, Ill., reports on her hospital’s plans to appeal a denied claim for an inpatient stay by KEPRO,a Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO). The episode generated national attention when it was reported that KEPRO revealed the existence of a secret CMS memo.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.100 Percent Error Rates, Every time: Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, reports on why he’s suspicious when auditors that review claims report 100 percent error rates, all the time.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, returns to report on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

Are recent denials by Medicare Advantage plans egregious examples of the insurance companies’ overreach? Or is there simply greater awareness of an age-old problem?Sorting out this ongoing issue during this edition of Monitor Mondays will be R. Phillip Baker, MD, medical director of case management at Self Regional Healthcare in Greenwood, N.C. and a member of the board of directors of the American College of Physician Advisors. Dr. Baker has been working with the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Group for the last two years, and has gotten them to put in writing statements noting that these plans have to follow original Medicare regulations for non-contracted facilities. The broadcast rundown also will include:Medicare Advantage Report: A central concern about the capitated payment model used by Medicare Advantage Organizations (MAOs) is the financial incentive for them to inappropriately deny access to services and reimbursements for services rendered in order to increase their profits, according to Knicole Emanuel, partner at the Potomac Law Group, who reports on this developing story.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron answers listeners’ questions from previous broadcasts on subjects that could be potentially troublesome.“Hello, Are You There?” Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, reports on problems now being created because a Quality Integrity Contractor (QIC) failed to respond to his appeal issues.When Minutes Count: Phones lit up and social media seemed to explode last week when CMS announced it might not allow minutes to count when therapy services are provided by students. The exclusive story was reported on RACmonitor by nationally renowned inpatient rehabilitation facility (IRF) expert Angela Phillips, the president and CEO of Image and Associates. Phillips reports on the details behind the news that is rocking IRF providers’ worlds.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, returns to report on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

Long awaited and hotly debated, the 2019 Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS) final rules have been on the minds of healthcare shareholders since late July, when the Centers for Medicare & Medicaid Services (CMS) released proposed rules for both. Tucked into the MPFS were the controversial revisions to the regulations governing evaluation and management (E&M) services.For an in-depth analysis of both the MPFS and the OPPS newly released final rules, Monitor Monday has brought together a pair of industry experts for this edition of the broadcast: Duane Abbey, president of Abbey and Abbey Consultants, and Sean M. Weiss, partner and vice president of compliance for DoctorsManagement.The broadcast rundown also will include:OIG Report: In a recent study, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reported that Medicare Advantage Organizations (MAOs) overturned 75 percent of their own prior authorization and claim denials from 2014 to 2016. Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, provides details on this latest developments.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will report on another example of a potentially troublesome issue that could pose a risk to your facility.TPE: Targeted probe-and-educate (TPE) audits are taking place in a variety of settings, from physical therapy providers to skilled nursing facilities (SNFs), including acute-care facilities. Reporting on TPE audits is Cindy Griffith, director of compliance and audits for ATI Physical Therapy.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.

Targeted probe-and-educate (TPE) reviews by the Medicare Administrative Contractors (MACs) give providers and suppliers three changes to get it right or they’re out. If there are continued high denials after the first three rounds of reviews, the provider is referred to the Centers for Medicare & Medicaid Services (CMS) to determine additional disciplinary action – either extrapolation, referral to the Zone Program Integrity Contractor (ZPIC) or Unified Program Integrity Contractor (UPIC), referral to a Recovery Audit Contractor (RAC), suspension of Medicare payments, or even revocation of Medicare billing privileges.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, managing partner of Wachler and Associates. Wachler offers some practical tips and strategic approaches for responding to TPE audits to reduce claim denials.The broadcast rundown also will include:Developing Story: PIM Change: CMS is proposing major changes to the Program Integrity Manual (PIM) – changes that will take effect Jan. 1, 2019. Senior healthcare analyst Frank Cohen, director of analytics and business intelligence for DoctorsManagement, reports on the changes involving sampling and extrapolation.Death by Cyber: RACmonitor investigative reporter and New York attorney Edward Roche suffered a life-threatening medical emergency while in Barcelona, Spain. Roche reports on the one mainstay of America’s hospitals that was missing while he was hospitalized and ultimately experienced a complete recovery.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest with TPE audits.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.Register now for this important news broadcast coming up at 10 a.m. EST on Monday, Oct. 15.

A False Claims Act lawsuit has been filed by Integra Med Analytics against Providence St. Joseph Health, seeking $188.1 million related to alleged upcoding of Medicare claims. According to media reports, Integra made the discovery of allegedly unwarranted major complication and comorbidity secondary codes. In its investigation, Integra identified J.A. Thomas and Associates (JATA) as the clinical documentation improvement consultancy for Providence. The lawsuit alleges Providence and JATA were "pushing doctors to make unwarranted diagnoses" and "using leading queries to change doctors' original diagnoses." Reporting our lead story during this edition of Monitor Mondays will be False Claims Act attorney Mary Inman, partner in the London law office of Constantine Cannon. Also on board reporting the data analytics associated with this developing story will be senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: Michael Salvatore, MD, FACP reports on the ancient practice of alchemy and how its modern-day equivalency is turning health into disease. Dr. Salvatore is the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron continues his reporting on the perennial question, “should I refund an overpayment?” He will pose the question as a listener quiz. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics. Monitor with us™

“Podiatrists should not be discriminated against any further. E&M (evaluation and management) requirements are the same as (those for) other providers, and we should be reimbursed justly,” one podiatrist recently wrote, expressing his opposition to the Centers for Medicare & Medicaid Services’ (CMS’s) proposed E&M reimbursement changes in the recently posted 2019 Medicare Physician Fee Schedule. “If Medicare is going to change E&Ms to only two codes, then all specialists should be changed,” another opined. “All I have to ask is what about optometrists? Why aren't you focused on them as well?” Reported by RACmonitor, the controversy centers on the proposal by CMS to reimburse new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate), while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215. Code 99211 would also be paid a lower rate. The level 1 codes don’t get the flat rate, because they don’t require the presence of a physician. Reporting on this developing story on this edition of Monitor Mondays will be Jeffrey D. Lehrman, DPM, diplomate of the American Board of Foot and Ankle Surgery. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: The proposed E&M changes are expected to impact providers’ bottom lines. But by how much? Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, has done the math and shares his analysis. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. False Claims Act Report: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on the $65 million settlement by Prime Healthcare to resolve allegations that its hospitals submitted false Medicare claims. Medicare Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare compliance. Monitor with us™

The Centers for Medicare & Medicaid Services’ (CMS’s) proposed evaluation and management (E&M) code changes in the recently posted 2019 Medicare Physician Fee Schedule continue to generate controversy. The controversy centers around the proposal by CMS to reimburse new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate), while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215. Code 99211 would also be paid a lower rate. The level 1 codes don’t get the flat rate, because they don’t require the presence of a physician. Reporting this developing story during this edition of Monitor Mondays will be Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS) as well as president of coding and billing services and a partner at DoctorsManagement, LLC. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: Lori O’Hara, the lead of the additional documentation request (ADR), appeals, and clinical review team for Ensign Services, a provider of skilled nursing and assisted living services, reports on the impact of the Inpatient Prospective Payment System (IPPS) final rule as it pertains to skilled nursing facilities. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. IRF Report: One of the nation’s most respected authorities on Inpatient Rehabilitation Facility (IRF) provider issues, Angela Phillips, president and chief executive officer for Images & Associates, reports on IRF provisions that will be impacted by the IPPS final rule. Monitor with us™

The Medicare Physician Fee Schedule/resource-based relative value scale (MPFS/RBRVS) regulations were formally published in the Federal Register on July 27, 2018. The Outpatient Prospective Payment System/Ambulatory Payment Classifications (OPPS/APCs) was released two days prior. Both were reported by RACmonitor.  Although you can expect the final changes to published in early November, for a contemporary analysis listen to Duane Abbey during this edition of Monitor Mondays.  Duane Abbey is president of Abbey and Abbey Consulting, Inc., and is RACmonitor contributing editor and a frequent panelist on Monitor Mondays.   The broadcast rundown also will include: Monday Focus: Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS) as well as president of coding and billing services and a partner at DoctorsManagement, LLC, reports on the reaction to the proposed overhaul of the E&M guidelines by CMS. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Dr. Hirsch will also present the Monitor Mondays Listener Survey. Monitor with us™

Back in February, as reported by ICD10monitor, the American Hospital Association (AHA) changed coding rules, allowing case managers and social workers to assign Z codes—one of 88 assignable ICD-10 codes to report on claims for homelessness, low income, stressful work environment, low literacy, divorce, personal history of abuse, and many more. But not all healthcare professionals—including a number of physicians—are getting the message. To help clear up the confusion, Ellen Fink-Samnick, a nationally recognized expert on social determinants of health (SDoH), will report our lead story. Other segments to be featured on the broadcast include: Talk Ten Tuesday News Desk: Timothy Powell, a nationally recognized expert on regulatory matters including the False Claims Act, ZPIC audits, and the OIG, will return to report on the latest healthcare news. E&M Coding Update: Given the scale and potential impact of major E&M changes in the 2019 Medicare Physician Fee Schedule proposed rule, Grant Huang, director of content for DoctorsManagement, will report on the major overhaul being proposed by the Centers for Medicare & Medicaid Services (CMS). Tuesday Focus: Malnutrition: Severe protein calorie malnutrition is under high scrutiny from CMS, U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), and commercial insurers. Megan Cortazzo, MD, medical director of clinical documentation improvement and health information management at University of Pittsburg Medical Center, will report on why it is happening and how to ensure hospitals and providers get compensated for the services they are providing. Talk Ten Tuesdays. More than just talk.™

There’s a new and disturbing payer denial—a situation that has caught the attention of the Brundage Group. An insurance company removed the diagnosis of COPD exacerbation because the treating physician chose not to treat using steroids. Could this denial be happening at your facility? Dr. Brett Hoggard, chief medical officer for the Brundage Group, reports on this new and disheartening denial technique. The broadcast rundown also will include: The RAC Report: RACmonitor Legislative Analyst Emily Evans, managing director of health policy for Washington, D.C.-based Hedgeye, reports on the latest developments of the Recovery Audit Contractors (RACs). Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, anchors the broadcast. Nancy will also report on all the latest hot topics. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Dr. Hirsch will also present the Monitor Mondays Listener Survey. Monitor with us™

The 340B drug pricing program suffered a major setback Tuesday, when the U.S. Court of Appeals dismissed a key American Hospital Association (AHA) lawsuit to block $1.6 billion in cuts. The three-judge panel ruled that the lower court had properly dismissed AHA's case because the association failed to fulfill the legal prerequisites to judicial review. Reporting our lead story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel, a partner at the Potomac Law Group. The broadcast rundown also will include: False Claims Act Report: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on Health Quest. The system and some of its subsidiaries have agreed to pay more than $14.7 million to the federal government and an additional $895,427 to the state of New York to resolve False Claims Act allegations that they submitted claims to government payers for evaluation and management (E&M) services that were billed two levels higher than was supported by the medical record. IRF Report: One of the nation’s leading Inpatient Rehabilitation Facility (IRF) authorities, Angela Phillips reports on the fact that IRFs that received a notice of non-compliance and believe the notice is in error have only until Aug. 7, 2018to submit a request for reconsideration. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monitor with us™

Case managers being situated in the emergency department (ED) appears to be a trend that is gaining traction nationwide, as results indicate that such a move helps determine appropriate status while also identifying patients who are appropriate for placement into a skilled nursing facility (SNF) directly (instead of placing them into the hospital while searching for a facility). We have two reports on this trending topic during this edition of Monitor Mondays. Leading our report is Juliet Ugarte Hopkins, a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. Dr. Hopkins will also report on structured interdisciplinary bedside rounds (SIBRs), an emerging practice that allows collaboration with the care team on a daily basis. Providing a first-person perspective on the role of case managers as registered nurses in the ED will be Kathleen K. Borchard, an RN case manager at Waukesha Memorial Hospital, also in Wisconsin. The broadcast rundown also will include: RAC Report: Healthcare attorney Knicole Emanuel, a partner at the Potomac Law Group, has the latest news on the Recovery Audit Contractors (RACs). Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on the 2019 Proposed Medicare Physician Fee Schedule’s impact on outpatient therapy. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, reports on the 2019 Proposed Medicare Physician Fee Schedule released by CMS on Thursday. Monitor with us™

The state of Kentucky has introduced Medicaid work requirements. And the trend seems to be proceeding fast and furiously in other states looking to cut health and behavioral health benefits of Medicaid enrollees, with officials saying the costs can’t be met otherwise. Kentucky eliminated vision and dental benefits to 500,000 Medicaid enrollees within 36 hours of the federal decision. Imagine the impact to the readmissions quagmire if benefits continue to be cut for the most vulnerable and disenfranchised members of society, or those most impacted by the social determinants of health (SdoH). These costs are already eye-raising: $1.7 trillion is being spent annually on 5 percent of the population. Readmission penalties are barely being managed across all hospitals, especially the safety net facilities. What will the continued impact of forcing shifts in Medicaid benefits be for the patients who need them most? Reporting on this latest development during the next edition of Monitor Mondays is nationally recognized SDoH expert Ellen Fink-Samnick, author, consultant, and founder of EFS Supervision Strategies, LLC. The broadcast rundown also will include: Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on the largest-ever healthcare bust, involving more than $2 billion in fraudulent billings. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monitor with us™

The Office of Medicare Hearings and Appeals (OMHA) has implemented the long-awaited expansion to its Settlement Conference Facilitation (SCF) process. The process provides appellants and the Centers for Medicare & Medicaid Services (CMS) an opportunity to discuss a mutually agreeable resolution for claims appealed to the administrative law judge (ALJ) or Medicare Appeals Council (Council) levels of appeal. Reporting our lead story during the next edition of Monitor Mondays will be healthcare attorney Erin Diesel Roumayah with Wachler & Associates. The broadcast rundown also will include: Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, will report on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will report on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, will continue to report on the vexing issue of Medicare Advantage. Special Assignment: Author, educator, and consultant Duane Abbey, president of Abbey & Abbey Consultants, Inc., will report on the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.r, a senior healthcare consultant for DoctorsManagement, will continue to report on the vexing issue of Medicare Advantage. Monday Rounds: Christopher Halleman, DO, physician advisor at the Brundage Group, will be making his Monday Rounds, substituting for Dr. Ronald Hirsch, who is on assignment. Monitor with us™

The National Institutes of Health (NIH)is expected to receive an additional $500 million to spend annually on pain management and opioid use. On Tuesday, the agency published details as to how the infusion of additional money will be used as part of a program titled “Helping to End Addiction Long Term (HEAL)." Earlier this week, the Centers for Medicare & Medicaid Services (CMS) approved facet joint injections for auditing, warning that auditors will review medical documentation to determine that services were medically reasonable and necessary. Reporting on this latest development will be American Medical Association (AMA) author and consultant Deborah Grider. Grider will also preview her upcoming webcast on the coding and documentation of pain management injections to avoid audits and takebacks. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser, with Fredrikson & Byron, reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Special Assignment:Senior healthcare analyst Frank Cohen will return to the broadcast to continue his reporting of alleged bias he is uncovering in extrapolation audits Monitor with us™

Not unexpected but widely feared among healthcare providers, regulations setting 340B ceiling prices and establishing civil monetary penalties for drug manufacturers that knowingly and intentionally exceed those limits were delayed for the fifth time, until 2019, by the Trump Administration in a final rule published on Tuesday, June 5 in the Federal Register. As the dust settles, America’s rural hospitals are expected to be impacted the most by an apparent lack of government enforcement, as the savings they receive from their participation in the 340B program —savings that are intended to keep doors open and allow for the provision of care for low-income and rural patients—are crucial to their survival. Reporting on this developing story during the next edition of Monitor Mondays will be Maureen Testoni, Interim President and Chief Executive Officer for 340B Health, a nonprofit organization of more than 1,300 hospitals and health systems participating in the federal 340B drug pricing program. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment. Special Assignment: Senior healthcare analyst Frank Cohen will return to the broadcast to continue his reporting of alleged bias he is uncovering in extrapolation audits. Cohen is expected to report on how a Zone Program Integrity Contractor (ZPIC) turned a $4,000 overpayment into a $3 million overpayment using extrapolation. Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, will have an update on the major whistleblower case that is pitting Aetna against CVS for price spreading—this at a time when the two entities are trying to merge. Risky Business: Healthcare attorney David Glaser, with Fredrikson & Byron, will report on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, will continue to report on the vexing issue of Medicare Advantage. Monitor with us™

“Literally billions of dollars a year are being extorted from healthcare providers due to a system of rules, regulations, and guidelines that are not outdated, but just plain wrong,” writes senior healthcare analyst Frank Cohen, director of analytics and business Intelligence for DoctorsManagement in the current edition of the RACmonitor e-News. Cohen joined the Monitor Mondays broadcast to make his case and suggest strategies for improving what he believes is a flawed system of medical record auditing. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. OMHA Report: Healthcare attorney Andrew Wachler, managing partner at Wachler & Associates, reports on the long-awaited expansion to the Settlement Conference Facilitation (SCF) program. Details were released last week by the Office of Medicare Hearings and Appeals. Audit Report: Monitor Mondays national correspondent Knicole Emanuel, Esq., partner at the Potomac Law Group, reports on the latest activities by healthcare auditors.  Risky Business: Healthcare attorney David Glaser, with Fredrikson & Byron, reports another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monitor with us™

The subject of total knee replacement (TKR) continues to reverberate. In this edition of Monitor Monday, Lori O’Hara, the lead of the ADR, appeals and clinical review team for Ensign Services, a provider of skilled nursing and assisted living services, will offer the perspective of a long-term care provider. Her position is that a TKR patient either needs medical oversight or they do not. The question of the proper environment, O’Hara answered by finding where the patient’s medical and functional presentation intersects the lowest level of safe care. The broadcast rundown also will include: E&M Services: Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS), reports on E&M levels four and five. Monday Newsmakers: Tim Brundage, MD, medical director at the Brundage Group, reported live from the ACDIS convention taking place in San Antonio, Texas. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reported on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser, with Fredrikson & Byron, reported on another example of a potentially troublesome issue that could pose a risk to your facility Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare Advantage. Monitor with us.™

The Health Resources and Services Administration (HRSA), which administers Section 340B of the Public Health Service Act, has published a proposal to delay for another year the ceiling price and civil monetary penalties regulation that was originally issued by the outgoing Obama Administration in January 2017. It was formally published on Monday. National Correspondent Timothy Powell reported our lead story on this episode of Monitor Mondays on 340B. The broadcast rundown also will include: Monday Focus: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, reported on a whistleblower case that is attracting unprecedented media coverage—the nurse who knew too much. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, made his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, reported on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reported on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays National Correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continued to report on the vexing issue of Medicare Advantage. Monitor with us.™

First Healthcare Compliance hosts Kelly Ogle, BSDH, MIOP, CMPM®, CHOP® an OSHA and HIPAA Specialist from DoctorsManagement, for an interactive discussion on “Ergonomics for Medical and Dental Professionals.” Ms. Ogle will give a complete overview of what ergonomics is and what is caused by not using proper precautions in your job. There will be a... The post Ergonomics for Medical and Dental Professionals appeared first on First Healthcare Compliance.

First Healthcare Compliance hosts Kelly Ogle, BSDH, MIOP, CMPM®, CHOP® an OSHA and HIPAA Specialist from DoctorsManagement, for an interactive discussion on “Ergonomics for Medical and Dental Professionals.” Ms. Ogle will give a complete overview of what ergonomics is and what is caused by not using proper precautions in your job. There will be a The post Ergonomics for Medical and Dental Professionals appeared first on First Healthcare Compliance.

The dust has yet to settle from last week’s posting by the Centers for Medicare & Medicaid Services (CMS) of the 2019 Medicare Inpatient Prospective Payment System (IPPS) proposed rule, and already Inpatient Rehabilitation Facility (IRF) providers appear to be experiencing relief not typically associated with other proposed rule changes. For them, the proposals from CMS for FY 2019 reflect some positive changes related to reductions in paperwork and, if finalized, they will provide some easing of the workload. One of the nation’s most respected authorities on IRF provider issues, Angela Phillips, president and chief executive officer for Images & Associates, reported on the proposed IRF provisions in the IPPS during this edition of Monitor Mondays. The broadcast rundown also will include: Monday Focus: RACmonitor Legislative Analyst Emily Evans, managing director of health policy for Washington, D.C.-based Hedgeye, reported on what she sees as major themes of the Trump administration’s rulemaking that has been reflected in the proposed rule, including administration burden reductions, price transparency, and meaningful use measures. Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, made his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, reported on all the latest hot topics and presented the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reported another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continued to report on the vexing issue of Medicare Advantage. Monitor with us.™

The problem begins like a blip on the radar screen: a curious anomaly that gradually grows more menacing. That is what Andrew Hughes, MD, and Charles Locke, both at Johns Hopkins, are noticing: an uptick in denials related to level of care provided versus the level of care billed. The majority of the denials arise when documentation indicates that a patient is "stable for downgrade" and a transfer has been initiated but not yet effectuated due to a lack of an available bed, reported Dr. Hughes, who was the special guest on this edition of Monitor Mondays. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, made his Monday Rounds with another installment of his popular segment. Whistleblower Update: Mary A. Inman, partner at Constantine Cannon's law offices in London, reported on the Aetna lawsuit filed against CVS Caremark accusing the pharmacy benefit manager of the giant retail pharmacy operation of improperly reporting Medicare generic drug prices to the Centers for Medicare & Medicaid Services (CMS). Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reported on another example of a potentially troublesome issue that could pose a risk to your facility. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Medicaid Report: Healthcare attorney Knicole Emanuel, partner in the Potomac Law Group, returns to the broadcast with the final installment of her exclusive two-part reporting on a state-by-state review of states' Medicaid regulatory oversight. Monday Focus: The Bipartisan Budget Act of 2018 contains a number of healthcare issues that have caught the attention of author, educator, and consultant Duane Abbey, who outlined them during the broadcast. Monitor with us™

Could non-physician practitioners (NPPs) be the next target of auditing by the Centers for Medicare & Medicaid Services (CMS) and private payer auditors? While physicians reportedly represent nearly a million targets for audits, add in another couple of hundred thousand nurse practitioners (NPs) and physician assistants (PAs) and target acquisition becomes that much richer. And in their minds, so do the auditors, according to Frank Cohen, director of analytics and business intelligence for DoctorsManagement, who reports on his latest findings during this episode. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Medicaid Report: Healthcare attorney Knicole Emanuel, partner in the Potomac Law Group, returns to the broadcast with the final installment of her exclusive two-part reporting on a state-by-state review of states' Medicaid regulatory oversight. Monday Focus: Former First Lady Barbara Bush died Tuesday at age 92 at her home in Houston, having decided to decline further medical treatment for health problems and instead to focus on "comfort care." Reporting on palliative care is Michael A. Salvatore, MD, physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. Salvatore is a member of the RACmonitor editorial board. Monitor with us™

Facebook CEO Mark Zuckerberg faced two days of grilling by Congress last week to address data misuse in the wake of revelations that millions of Facebook users had their private information given away to political consulting firm Cambridge Analytica in the run-up to the 2016 Presidential election. Zuckerberg testified before Congress that about 87 million users had their Facebook data taken without their permission. Of those users, many were healthcare professionals who inadvertently allowed hackers and criminals the information they need to break into healthcare systems. Reporting this developing story will be RACmonitor national correspondent and healthcare consultant Timothy Powell. Powell will describe how you can avoid getting your facility ensnarled in the phishing trap. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Medicaid Report: Healthcare attorney Knicole Emanuel, partner in the Potomac Law Group, returns with the first part of her exclusive two-part reporting on a state-by-state of review of states' Medicaid regulatory oversight. Medical Necessity: Senior healthcare consultant Kristi Pollard reports on best practices for coding medical necessity on outpatient claims. Pollard is a senior coding consultant at Haugen Consulting Group. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Monitor with us™

Judge James E. Boasberg of the United States District Court for the District of Columbia has ordered the American Hospital Association (AHA) to propose specific recommendations for reducing the Medicare appeals backlog of appeals at the Administrative Law Judge (ALJ) level. Reporting this developing story is healthcare attorney Andrew Wachler, Esq., managing partner at Wachler and Associates. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, report on all the latest hot topics and presents the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Consumer Alert: New Medicare beneficiary identification cards are scheduled to be mailed from the Centers for Medicare & Medicaid Services (CMS) this month to beneficiaries. And with the new cards come new scams. Author, educator, and consultant Duane Abbey will report on the new cards and the expected scams on bilked seniors. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Monitor with us™

Telemedicine, considered to be an electronic lifeline for rural healthcare, is a rapidly growing sector of health care in the United States that has recently gone through a significant expansion. Returning to Monitor Mondays to provide an update to his October 2017 report on the CHRONIC Act and MedPac's report on Telemedicine, is attorney Dale C. Van Demark, a partner at McDermott Will & Emery in Washington, D.C. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, returns to report on all the latest hot topics and the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. 340B Update: Monitor Mondays national correspondent Timothy Powell, CPA, reports on the status of the controversial 340B drug program. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Monitor with us™

Diving deep into the datasphere, senior healthcare analyst Frank Cohen comes up for air in order to report on a new approach he and his team of data experts have developed to predict the likelihood of an audit. While he claims that his team is not yet predicting billing errors, he does report that many of the variables being used to do so can also be used to forecast audits. During this episode Cohen, director of analytics and business intelligence for DoctorsManagement, reports on his latest findings, which could help you and your facility ward off an audit. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, returns to report on all the latest hot topics and the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. IRF Update: Angela Phillips, one of the nation's foremost authorities on inpatient rehabilitation facilities (IRFs), reports on all the buzz about Medicare's most recent clarifications to contracted auditors related to auditing therapy minutes for IRFs. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Monitor with us™

"Anthem Blue Cross Blue Shield (BCBS) was set to implement a new processing edit with regard to the use of Modifier 25, effective March 1, 2018, but things didn't go as planned," reports Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS), as well as the president of coding and billing services and a partner at DoctorsManagement, LLC. During this episode DeConda explains why Anthem is rescinding the new policy. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. IRF Update: Angela Phillips, one of the nation's foremost authorities on inpatient rehabilitation facilities (IRF), reports on Medicare guidelines for an "interrupted stay" in the IRF, and for how services should be billed for these patients. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron shares another example of a potentially troublesome issue that could pose a risk to your facility. Whistleblowers: Nationally recognized whistleblower attorney Mary Inman will reports on current whistleblower cases from the London offices of her firm, Constantine Cannon. Monitor with us™

Who bears the burden and blame of regulatory noncompliance when your facility relies on non-medical software companies that create electronic medical records? We will continue with the second part of this developing story during this episode of Monitor Mondays, when whistleblower attorney Mary Inman reports on an ongoing qui tam action under the federal False Claims Act through which a relator alleges that Bon Secours Health System, Inc. fraudulently billed Medicare and Medicaid millions of dollars. Inman also reports on other current whistleblower cases. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, has all the latest developments on the therapy caps as well as the Monitor Mondays Listener Survey. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer continues to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on a recent memo from the U.S. Department of Justice offering good news for some providers. 340B Drug Update: RACmonitor national correspondent Timothy Powell, CPA, reportS on the latest developments regarding the 340B drug discount program. Monitor with us™

On the rugged regulatory terrain, you might confront this issue: who bears the burden and blame of regulatory noncompliance when your facility relies on non-medical software companies that create electronic medical records? Many of these electronic records are self-populated. So, what happens if you undergo a Recovery Audit Contractor (RAC) audit and are accused of wrongdoing? Offering insight into this issue during the next edition of Monitor Mondays will be healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, who will be the broadcast's special guest. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest hot topics and the Monitor Mondays Listener Survey. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer will continue to report on the vexing issue of Medicare Advantage. Spencer is a senior healthcare consultant for DoctorsManagement. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will report on a recent memo from the U.S. Department of Justice offering good news for some providers. Cyber Report: RACmonitor investigative reporter and New York attorney Edward Roche will report on risks associated with Apple's iPhone's new medical records portal. Roche is the director of scientific intelligence for Barraclough NY LLC. Monitor with us™

Healthcare Effectiveness Data and Information Set (HEDIS) reviews, underway right now by commercial health plans and government payers, are expected to continue through mid-May. Also expected at that time is a massive number of medical record requests from payers as they seek to improve their Medicare Advantage plan quality measurements, called Star Ratings, which are ultimately published on the Centers for Medicare & Medicaid Services (CMS) website. Explaining the rating systems as well as offering best practices to minimize payer abrasion during this episode of Monitor Mondays is special guest Greg Ford with MRO. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will file another report on the controversial total knee replacement (TKR) issues that continue to confound physicians and patients. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest hot topics and the Monitor Mondays Listener Survey. Medicare Advantage Report: Monitor Mondays national correspondent J. Paul Spencer will respond to a listener who become ensnared in a Medicare Advantage issue. Spencer is a senior healthcare consultant for DoctorsManagement. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will return with another example of a potentially troublesome issue that could pose a risk to your facility. Prickly Report: Implantable medical device reporting is the prickly subject for the Monitor Mondays Prickly Report. It’s a compliance issue that still confounds providers while at the same time continues to be a hot audit topic for Zone Program Integrity Contractors (ZPICs), Comprehensive Error Rate Testing (CERT), and Medicare Administrative Contractors (MACs). Michael Calahan, vice president of hospital and physician compliance with HealthCare Consulting Solutions (HCS), will explain why this issue is low-hanging fruit for auditors. Monitor with us™

“We have been slammed with Medicare Advantage DRG audits,” wrote Sandra from Indiana during last week’s Monitor Mondays broadcast. We asked RACmonitor national correspondent J. Paul Spencer with DoctorsManagement to investigate this issue for this week's episode. Will there be more of these audits? Do these represent low-hanging fruit for auditors? Stay tuned. The episode rundown also includes: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will file another report on the controversial total knee replacement (TKR) issues that continues to confound physicians and patients. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO for Nancy Beckley and Associates, will have all the latest hot topics and the Monitor Mondays Listener Survey. Healthcare Cyber Report: RACmonitor investigative reporter and New York attorney Edward Roche will return to the broadcast to report shocking examples of cyberattacks on healthcare providers. Roche is the founder and director of scientific intelligence for Barraclough LLC New York. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will return after a long absence with another example of a potentially troublesome issue that could pose a risk to your facility. OMHA Report: Prominent healthcare attorney Andrew Wachler, managing partner at Wachler & Associates, will report on the latest offering from the Office of Medicare Hearings and Appeals to expand its current Settlement Conference Facilitation (SCF) program. Monitor with us™

  First Healthcare Compliance hosts Shannon DeConda of NAMAS and DoctorsManagement for an interactive discussion on “Making the Complexities of E&M Auditing Simplistic in Approach and Understanding for Complete Physician Buy-In.” During this session, we will take actual medical records and break them down from an auditing analysis point of view. We will walk through The post Making the Complexities of E&M Auditing Simplistic in Approach and Understanding for Complete Physician Buy-In appeared first on First Healthcare Compliance.

  First Healthcare Compliance hosts Shannon DeConda of NAMAS and DoctorsManagement for an interactive discussion on “Making the Complexities of E&M Auditing Simplistic in Approach and Understanding for Complete Physician Buy-In.” During this session, we will take actual medical records and break them down from an auditing analysis point of view. We will walk through... The post Making the Complexities of E&M Auditing Simplistic in Approach and Understanding for Complete Physician Buy-In appeared first on First Healthcare Compliance.

An interview with Valora Gurganious, Partner and Senior Management Consultant at DoctorsManagement, LLC. What is DoctorsManagement and what do you offer? DoctorsManagement, LLC (DM) is a leading provider of business solution services to a wide variety of organizations including leading academic institutions, integrated delivery health systems, physician owned and managed groups, and more than 30 law The post First Healthcare Compliance Podcast- DoctorsManagement appeared first on First Healthcare Compliance.

An interview with Valora Gurganious, Partner and Senior Management Consultant at DoctorsManagement, LLC. What is DoctorsManagement and what do you offer? DoctorsManagement, LLC (DM) is a leading provider of business solution services to a wide variety of organizations including leading academic institutions, integrated delivery health systems, physician owned and managed groups, and more than 30 law firms that... The post First Healthcare Compliance Podcast- DoctorsManagement appeared first on First Healthcare Compliance.