Podcast appearances and mentions of frank cohen

A recent case, United States v. Junyi Liu, reveals how a $23 million fraud scheme exemplifies vulnerabilities in America's healthcare system – as you'll discover when senior healthcare analyst Frank Cohen joins the next Monitor Monday broadcast.You'll also learn about the challenges legitimate providers face when navigating complex regulations – and more about the government's aggressive “pay-and-chase” enforcement tactics, plus why innocent practitioners often get caught in the crossfire.During the next live edition of the venerable weekly Internet broadcast, Cohen will also report on potential policy reforms.The long-running broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Monday Rounds: Dr. Bonney Olney, director of Level of Care Service for R1 RCM, will make her Monday rounds, substituting for Dr. Ronald Hirsch.

Across America, in sprawling university teaching facilities and in picturesque rural hospitals, administrators are dealing with a powerful tool called statistical extrapolation.When auditors say that they're using statistical “sampling” to review your Medicare claims, what they are often doing is using extrapolation – which could take what might appear to be minor discrepancies in your billing and turn them into major financial obligations.To learn more about extrapolation and what it means for you and your team, the producers of RACmonitor have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of Monitor Mondays.The venerable weekly Internet broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

Artificial intelligence (AI) is becoming as commonplace in healthcare as billing audits.It's ubiquitous.And that is why the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to explore the intersection of AI and healthcare. So, during the next live edition of the venerable live weekly Internet broadcast, Cohen will address key concerns for compliance professionals, including Health Insurance Portability and Accountability (HIPAA) requirements, data governance, and responsibility in AI-driven decision-making.The broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.

Looking to unravel healthcare's complex issues? Looking to streamline your operations and improve decision-making?Join us this coming Tuesday, Jan. 14 at 10 a.m. EST, when the long-running Talk Ten Tuesdays kicks off its 2025 broadcast season with special guest Frank Cohen, senior director of analytics for VMG Health. Cohen will share his insight on Hanlon's Razor, a principle that can be summarized as “never attribute to malice that which can be adequately explained by incompetence.”This principle isn't about blame-sharing, but rather about how to foster empathy and clarity while also helping to develop constructive problem-solving.Also part of the broadcast will be these instantly recognizable panelists, who will report more news during their segments:• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH.• CDI Report: Cheryl Ericson, Director of clinical documentation integrity (CDI) for the vaunted Brundage Group, will make her debut appearance as the broadcast's CDI correspondent.• The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news.• News Desk: Timothy Powell, ICD10monitor national correspondent and regulatory expert, will anchor the Talk Ten Tuesdays News Desk.• MyTalk: Angela Comfort, veteran healthcare subject expert, will begin the 2025 Talk Ten Tuesdays broadcast season as the co-host for the long-running and popular weekly Internet broadcast. Comfort, assistant vice president of revenue integrity for Montefiore Health, assumes the broadcast job following the expected departure of Erica Remer, MD.

This episode has been in the works for a little over 3 years now. My original intention was to meet the members of Brass Against and talk to the brass players about the band and all kinds of other topics. I followed up on the message about 2-3 months ago and I received a response. (I was one happy camper) They said, “Frank will do it!” So then I began researching Frank Cohen. After falling into that rabbit hole I discovered, Frank has done a lot! He's a member of Brass Against and he currently is lead trombone/soloist with Arturo O'Farrill and the Afro Latin Jazz Orchestra, with Willie Colon, and is a member of the High and Mighty Brass Band. Mr. Cohen has great life experiences as a musician that we can all learn from, maybe some can relate to, but most of all we have found another trombone treasure! https://rathtrombones.com/robert-kaip-loves-his-rath-2/ https://www.highandmightybrassband.com/  

Worried about billing and coding errors leading to financial penalties? Join Becker's Healthcare as Pam D'Apuzzo and Frank Cohen, compliance experts from VMG Health, discuss how to build a continuous improvement model. Learn why regular risk analyses are crucial, how auditing complements them, and practical solutions to overcome common challenges. Take control of your compliance strategy and ensure financial health.This episode is sponsored by VMG.

Auditors use the Comprehensive Error Rate Testing (CERT) study from the Centers for Medicare & Medicaid Services (CMS) as a way to target individual providers for potential recoupment. For example, if you get paid millions of dollars for some procedure codes or DRGs that have high error rates, it increases the likelihood that those specific codes and/or DRGs will be audited. Why? Because, statistically speaking, whatever the error rate reported by CERT is can help estimate the potential improper payments made to a given provider and/or organization.During the next live edition of the venerable Monitor Monday broadcast, senor healthcare analyst Frank Cohen will return to continue his series on CERT.Broadcast segments will include these instantly recognizable features:•Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.•The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. •Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.•Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.•Lead Story: Senior healthcare analyst Frank Cohen will continue with his reporting on the CMS program CERT.

What's important to know about the Comprehensive Error Rate Testing (CERT) program from the Centers for Medicare & Medicaid Services (CMS) is that auditors rely upon the results to target specific providers for recoupment audits.The more you know about CERT and the study results, the better position you will be in when it comes to understanding both the general risk of an audit and the specific areas that might be at risk within your organization, according to senior healthcare analyst Frank Cohen. Cohen, long associated with Monitor Mondays, will return to the famed weekly Internet broadcast this coming Monday to begin a series on CERT: the Good, the Bad, and the Ugly.Broadcast segments will include these instantly recognizable features:•Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.•The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. •Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.•Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on current healthcare legislation.•Lead Story: Senior healthcare analyst Frank Cohen will return to Monitor Mondays to begin a new series on the CMS program CERT.

Last year, healthcare professionals saw many of the rules for evaluation and management (E&M) services that were implemented in 2021 now applied to 2023 E&M codes. This included codes representing services for hospital inpatient care (99221-99223 and 99231-99233), emergency department visits (99281-99285), nursing facility visits (99307-99210), and all consultation services.How are these changes likely to impact 2024 E&M coding? Senior healthcare consultant Frank Cohen, founder of the Frank Cohen Group, will report on the significant impact of these changes during the next live edition of Talk Ten Tuesdays.The live broadcast will also feature these other segments:• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news happening at the intersection of medical record auditing and the social determinants of health (SDoH).• RegWatch: Stanley Nachimson, founder of Nachimson Advisors, LLC, will report on the latest news regulatory news coming out of Washington, D.C.• News Desk: Timothy Powell, CPA, will anchor the Talk Ten Tuesdays News Desk.• 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.

Healthcare providers nationwide are facing menacing interactions with auditors that, like hungry predators, are looking at submitted claims for the slightest evidence of omission or commission as the justification to pounce.But it's not so much the actual auditing as the long and wearisome journey of appeals – and the very real possibility of financial disaster. Although medical record auditing is not new, its frequency and alleged abuses contribute to a tell a tale of tragedy for America's healthcare system.That is why each and every Monday morning, Monitor Mondays has been alerting its listeners as to consequences of auditing gone awry – but also reporting on preventative measures providers can take to help their facilities avoid takebacks and fines.This coming Monday, Monitor Mondays will continue with its reporting on auditors behaving badly.That's when listeners will hear of complication and comorbidity (CC) risk scores: a relative measure of the average health (or lack of health) for a Medicare beneficiary. The higher the score, the more cost to the system, and subsequently, the higher the payment for care. Out of this model was born clinical documentation improvement, or CDI – a push to improve documentation so that it improves the reporting of diagnoses and procedures, thereby optimizing the scores. But with this comes the opportunity for abuse. So, can these risk scores help predict whether a provider is under-coding, over-coding, or coding optimally? Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on current healthcare legislation.The Cohen Report: Senior healthcare analyst Frank Cohen will file the second report in his two-part series on his research findings that Hierarchical Condition Category (HCC) risk scores could be used to negotiate Medicare Advantage rates.Livestream Chat: Dr.John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

Never-before-seen data has revealed that Hierarchical Condition Category (HCC) risk scores could predict under- or over-coding – and it will be the primary topic of discussion during the next live edition of Monitor Mondays.That's when senior healthcare analyst Frank Cohen will report on his findings. The HCC risk score is a relative measure of the average health (or lack of health) for a Medicare beneficiary. The higher the score, the more cost to the system, and subsequently, the higher the payment for care. Out of this model was born clinical documentation improvement, or CDI – a push to improve documentation so that it improves the reporting of diagnoses and procedures, thereby optimizing the scores. But with this comes the opportunity for abuse. So, can the HCC risk score help predict whether a provider is under-coding, over-coding, or coding optimally? Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Legislative Update: Cate Brantley, legislative analyst for Zelis, will report on current healthcare legislation.Livestream Chat: Dr.John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

On this episode of the Impact Real Estate Podcast presented by Jackson Lucas, we speak with Frank Cohen, the founder of PersonalSalary.com. We talk about transformed an idea and something he just had a interest in to a bonafide tool that is transforming the real estate business.NOW ON YOUTUBE! : https://www.youtube.com/@impactrealestatepodcastApple Podcasts: https://apple.co/2MQRXYWSpotify: https://spoti.fi/3cNfTHjWeb: https://www.jacksonlucas.com/podcast/frank-cohen05:26 - The idea is born 07:23 - Goals, goals, goals 12:25 - The first question ... what should we pay?16:00 - Late to the party 17:03 - Confidentiality 20:09 - Data evolution 24:59 - Gauging benefits 28:49 - Holding your nose 31:20 - The Hot Seat presented by KK Reset Take the Pay Transparency survey by visiting https://www.jacksonlucas.com/compensation-consulting

While the pandemic may have shielded healthcare providers from intrusive recoupment audits, the auditing break was but temporary. Starting in August of 2021, UPIC, TPE, RAC and other audits started back up and the contractors had a lot of catching up to do. At the same time, the administrative law judges were under enormous pressure to get the backlog of cases completed by the end of 2022. The result? A paradigm shift in how hearings were conducted and the impact that has on outcomes. Senior healthcare analyst and RACmonitor correspondent Frank Cohen will talk about how these changes have benefited providers in getting judges to vacate the extrapolation estimates.  Other segments will include these instantly recognizable broadcast segments:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Legislative Update: Cate Brantley, legislative affairs analyst for Zelis, will substitute for Matthew Albright to report on current healthcare legislation.

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

THE Podcast Episode 49 with Frank Cohen-5 Tips to Improve Decor by Mark Lipton

2021 brought a very significant change in how evaluation and management (E&M) visit codes are determined – and with that, concern over how it may impact coding behavior. The big concern: a shift from the lower-level visit codes to the higher-level visit codes: in particular, 99214, 99204, and 99205. The big question: is this shift justified, and does it change the potential for audit risk? Joining the next live edition of Monitor Mondays will be senior healthcare Frank Cohen, who will report the results of his study of more than 30,000 audits of office visit codes.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return 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, D.C.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.SDoH Report: Ellen Fink-Samnick,anationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.

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.

Join my conversation with former paint dealer and AllPro president Frank Cohen as we discuss his work as a decor consultant to independent paint dealers.

“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.

Frank Cohen the CEO and Founder of Clever Moe shares how to get customers using digital marketing. Get more info at https://CleverMoe.com/

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.

Billions of dollars in overpayments are levied annually against healthcare providers by the Centers for Medicare & Medicaid Services (CMS), based on the use of extrapolation audits. And while thousands of extrapolation audits are completed each year, the targeted provider or organization most likely will appeal the use of extrapolation.In nearly all cases, the appeal is focused on one or more flaws in the methodology used to create the sample and calculate the extrapolated overpayment estimate. But how do you uncover the flaws?Reporting our lead story during the next edition of Monitor Mondays, with answers to that question and others, will be Frank Cohen, senior healthcare analyst and director of business intelligence at DoctorsManagment.Other segments to be featured during the next live broadcast include the following: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.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.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.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.

Most physicians are expected to see in an increase in payments from Medicare, thanks to the latest COVID-19 relief bill. But with good news always comes some caution.First of all, the more that is paid, the more can be recouped during an audit. And with respect to provider compensation models that rely on relative value units (RVUs), it is possible that the increase in work RVUs may exceed the increase in the total RVUs – meaning that a provider may make more than what is proportional to overall practice revenue. This could have implications with respect to fair-market value, and should be watched very closely.Reporting our lead story on this timely matter during the next live edition of Monitor Mondays will be Frank Cohen, senior healthcare analyst and director of business intelligence at DoctorsManagment.Other segments to be featured during the live broadcast include the following: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.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.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.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.

We discussed descriptive, predictive and prescriptive analytics! Sounds complicated but Frank shared some real world examples about each. In addition, we talked about coding audits and the federal government approach in the rest of the year.

During this of Monitor Mondays, senior healthcare analyst Frank Cohen, a computational statistician, reports on how anecdotal thinking is not evidence-based thinking, and it is difficult to draw conclusions without having all of the information – noting that’s exactly what is happening right now, as America grapples with the coronavirus (COVID-19).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel files her Monitor Mondays RAC Report.Audit Report: Sean M. Weiss, reports on the next audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick, has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright 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 which he discusses swing beds, Telehealth and billing under COVID19.

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.

There was a time when therapy documentation was the focus of Recovery Audit Contractor (RAC) audits. Under the Patient-Driven Payment Model (PDPM), however, reimbursement for Medicare Part A patients being treated in skilled nursing facilities (SNFs) will be driven by patient condition, rather than therapy minutes. And this creates a target-rich opportunity for auditors, because certain documentation can easily lead to higher reimbursement – and the likelihood of audits leading to claim denials. Reporting on this development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Other segments to appear during broadcast include:Court Report: The Reckitt Benckiser Group has agreed to pay $1.4 billion to resolve its potential criminal and civil liability related to a federal investigation of the marketing of the opioid addiction treatment drug Suboxone. Whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on how an addiction specialist filed a False Claims Act (FCA) motion leading to the largest settlement in U.S. history related to the opioid crisis.Monday Focus: Senior healthcare analyst Frank Cohen returns to Monitor Mondays with a unique perspective on artificial intelligence (AI). Cohen reports on how the more accurate term for the ubiquitous AI should be “augmented intelligence,” as it relates to non-clinical areas of healthcare.SDoH Report: Ellen Fink-Samnick, nationally recognized expert on the social determinants of health (SdoH), will have 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 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.

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

How often have you heard someone say, “we’ve always done it that way?" The truth is, we too often depend upon traditions, emotions, politics, and anecdotes to make critically important business and management decisions. In this episode of MGMA Insider, Frank Cohen, MBB, MPA, Director of Analytics, Doctors Management LLC, discusses the history of critical thinking and the use of evidence in the form of data, statistics, and analysis in a medical practice. As Cohen explains, "Evidence-based thinking (EBT) incorporates techniques such as critical thinking, analytics, decision theory and problem-solving to improve our management skills and outcomes." Cohen will deliver the opening keynote address on evidence-based thinking at MGMA19 | The Data Conference, Thursday, May 16 in Orlando, Florida. The conference will run May 16-18 at the Walt Disney World Swan and Dolphin Resort. Podcast listeners interested in more information about this user group conference or looking to register can go to mgma.com/datacon

Editor’s note: All of today’s guests can be heard speaking at MGMA19 | The Data Conference, May 16-18 in Orlando, Florida. As a special offer to you, our podcast listeners can receive $200 off the regular registration price by entering the code PODCAST at mgma.com/datacon Healthcare’s business analytics market is projected to grow from $14 billion in 2019 to more than $50 billion by 2024. To help healthcare professionals better understand and utilize data in their practice, this episode of MGMA Insights is focused on providing information on how data can best be utilized in a medical practice. We also explain the importance of evidence-based thinking and discuss how to apply key metrics to a dataset. Experts and topics in this episode include: • Ashley Voss, Data Analyst II, MGMA, on data collection and analysis • Chris Addison, MBA, LSSGB, Student Health Services, on Lean principles and data-driven decisions • Lynda Barrie, Consultant, MGMA Consulting, on key metrics to use in datasets • Frank Cohen, MBB, MPA, Director of Analytics, Doctors Management LLC, on evidence-based thinking • Timothy Smith, CPA, ABV, Principal, TS Healthcare Consulting, on being a data skeptic Sources for this episode include: https://www.mgma.com/resources/financial-management/predicting-the-future-of-healthcare-with-analytics https://www.mgma.com/data/data-stories/the-power-of-benchmarking-data-for-healthcare-lead https://www.mgma.com/resources/financial-management/physician-practice-losses-using-loss-sourcing-ana https://www.mgma.com/resources/revenue-cycle/get-proactive-with-payments-how-medical-groups-ca If you like the show, please rate and review it wherever you get your podcasts. Every positive review helps new listeners find the show. If you have any questions, concerns, or ideas, please shoot us an email at podcasts@mgma.com or visit mgma.com/podcasts for our complete library of episodes. MGMA Insights is presented by Craig Wiberg, Decklan McGee, and Daniel Williams.

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™

2019 is shaping up to be another tumultuous year in healthcare. Decisions being made in Washington will impact every practice, facility, and health system. With so many major changes taking place, you need to stay informed and alert. And RACmonitor and Monitor Mondays will help you stay in front of the issues that will alter the delivery of healthcare now and for the next decade.Monitor Monday host and RACmonitor Publisher Chuck Buck will have the following all-star lineup of experts on hand to tell you what to watch out for in 2019 during the next edition of the weekly Internet broadcast:Duane Abbey, PhD; Janelle Ali-Dinar, PhD; Nancy Beckley, MS, MBA, CHC; Frank Cohen, MPA; William Dombi, Esq.; Knicole Emanuel, Esq.; David Glaser, Esq.; Ronald Hirsch, MD, FACP, CHCQM; Angela Phillips, PT; Lauren Riplinger, JD; Edward M. Roche, PhD, JD; and Andrew Wachler, Esq.All this and more will be coming your way as we help you anticipate what’s ahead in what is be expected to be another tumultuous year of healthcare auditing and compliance.

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.

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™

Movies discussed: Pride and Prejudice and Zombies, Night School, Hereditary, Don’t Turn Me Off (short) Join us for insightful discussions about Hereditary, Pride and Prejudice and Zombies, and Night School this week. Well, Josh and Charlie are insightful at least. Next weeks assignments: The Fury No One Lives Savage Land Clean Up (short) Clean Up from Frank Cohen on Vimeo. Watch along with us if you like and we’ll see you next week! The post Episode 281 – Love Shack Moment appeared first on Horror Show Hot Dog.

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™

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™

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™

This episode, we explore some key takeaways from MGMA 2017 Annual Conference, with selections from speakers including MGMA President and CEO Dr. Halee Fischer-Wright, leadership expert Tracy Spears, former MGMA Small Talk guest Frank Cohen and others. For more insights from the MGMA 2017 Annual Conference, on-demand sessions are available in the MGMA Store: mgma.org/store. Producer: Decklan Miller-McGee, MGMA instructional developer AUDIO: "Mountain Top," Audiobinger (CC BY-NC 4.0)

Frank Cohen, MBB, MPA, director of analytics, Doctors Management LLC, Clearwater, Fla., discusses how predictive analytics is already being used by CMS to detect fraud and how this new technology could help practices make better business decisions. Cohen will led a preconference session, "From Data to Action: Benchmarking for Better Results in your Practice," on Sunday, March 4, 2018, at the MGMA 2018 Financial Conference in Orlando, Fla. Learn more: http://www.mgma.com/tfc.

With John Wilson In Iron Man 3, Robert Downey Jr reprises his role as super-hero of the Marvel comics. The film also stars Gwyneth Paltrow and Rebecca Hall. Naomi Alderman reviews. More from the Cultural Exchange project, in which 75 leading creative minds share their passion for a book, film, poem, piece of music or other work of art. Tonight ballerina Tamara Rojo selects the pioneering choreographer who inspired her to dance, Mats Ek. At the age of 10 in Madrid, Tamara saw the Swedish choreographer's groundbreaking ballet Bernarda, based on the Lorca play The House of Bernarda Alba. As a staff photographer for the Magnum agency, Rene Burri captured some of the defining moments of the 20th century. As he publishes a new book of colour photographs, he describes the moment he captured an image of his hero, Pablo Picasso. Art collector Frank Cohen, who made his fortune by creating a chain of DIY stores, and his business partner Nicolai Frahm are opening a new free gallery in London, on the vast site of a former dairy. Where milk bottles used to be washed and stored, contemporary art from around the world will now hang. They discuss their approach to art collecting, and the desire to put it on show. Producer Penny Murphy.

Bearing the title "Collateral Damage," the Concerto for Clarinet and Orchestra was composed for clarinetist and former colleague Håkan Rosengren. It was completed over a six week period during the months of February and March of 2000 and was premiered by Peter Wright (Principal Clarinetist) and the Jacksonville Symphony Orchestra (Fabio Machetti, Conductor) on March 3 & 4, 2005 at the Times-Union Performing Arts Hall in Jacksonville, Florida. The work was also performed by Frank Cohen and the Cleveland Orchestra in July, 2005 at Blossom Music Pavillion. The 20 minute work is somewhat eclectic and post modern in style and follows the traditional three movement form. The faster outer movements are a musical blend of both contemporary classical and Eastern European folk idioms. By contrast, the slower middle movement incorporates musical elements that characterize some of the popular music of the late 20th century. Inspired largely by the tragic events which surrounded the break-up of the former Yugoslavia during the 1990's, the work is dedicated to the civilian victims of all modern wars. The second movement features the clarinet spinning out a continuously evolving and expanding melody over a series of recurring but shifting harmonic patterns. The title "Funeral for a Rock Star" is a concise description of the imagery and emotion that the music seeks to convey. The seemingly improvisatory and unrestrained clarinet solo evokes the image of a soul freely born aloft, while the heavy, plodding undercurrent of low brass and strings reveals a procession of loved ones bearing the weight of a casket and a profound grief whose consolation lies somewhere between memory and hope.

Collateral Damage for Clarinet and Orchestra (2000) A Concerto for Bb Clarinet and Orchestra A standard three movement concerto for Solo Clarinet and Orchestra 2222/4331/3perc/timp/Strings. I. A Bosnian Rhapsody II. Funeral for a Rock Star III. Serbian Hoedown (The bombs fly but the band plays on) Total duration of the work is about 20 minutes. Bearing the title "Collateral Damage," the Concerto for Clarinet and Orchestra was composed for clarinetist and former colleague Håkan Rosengren. It was completed over a six week period during the months of February and March of 2000 and was premiered by Peter Wright (Principal Clarinetist) and the Jacksonville Symphony Orchestra (Fabio Machetti, Conductor) on March 3 & 4, 2005 at the Times-Union Performing Arts Hall in Jacksonville, Florida. The work was also performed by Frank Cohen and the Cleveland Orchestra in July, 2005 at Blossom Music Pavillion. The 20 minute work is somewhat eclectic and post modern in style and follows the traditional three movement form. The faster outer movements are a musical blend of both contemporary classical and Eastern European folk idioms. By contrast, the slower middle movement incorporates musical elements that characterize some of the popular music of the late 20th century. Inspired largely by the tragic events which surrounded the break-up of the former Yugoslavia during the 1990's, the work is dedicated to the civilian victims of all modern wars. The rousing and spirited finale "Serbian Hoedown" (The bombs fly but the band plays on) takes its inspiration from those men and women who would congregate on the bridges during the bombing raids in Serbia in the spring of 1999. They often passed their time with defiant speeches and traditional folk singing and dancing in the hope that the massive structure - which they depended on for their general livelihood and security - would not be targeted and destroyed. Here the clarinet, performing melodic material steeped in Serbian folk-dance idioms, seems to lead the orchestra through a series of climaxes and mishaps (even reviving the ensemble at one point) as melodic materials first presented by the solo clarinet are taken up by the accompanying ensemble.

Bearing the title "Collateral Damage," the Concerto for Clarinet and Orchestra was composed for clarinetist and former colleague Håkan Rosengren. It was completed over a six week period during the months of February and March of 2000 and was premiered by Peter Wright (Principal Clarinetist) and the Jacksonville Symphony Orchestra (Fabio Machetti, Conductor) on March 3 & 4, 2005 at the Times-Union Performing Arts Hall in Jacksonville, Florida. The work was also performed by Frank Cohen and the Cleveland Orchestra in July, 2005 at Blossom Music Pavillion. The 20 minute work is somewhat eclectic and post modern in style and follows the traditional three movement form. The faster outer movements are a musical blend of both contemporary classical and Eastern European folk idioms. By contrast, the slower middle movement incorporates musical elements that characterize some of the popular music of the late 20th century. Inspired largely by the tragic events which surrounded the break-up of the former Yugoslavia during the 1990's, the work is dedicated to the civilian victims of all modern wars. The opening movement is titled "A Bosnian Rhapsody" and is the longest and structurally the most complex of the three movements. It is built on two contrasting themes, one faster and the other much slower, each set in tonalities that are a semi-tone apart. These original themes incorporate harmonic and melodic idioms commonly found in the music of the balkans and they give the opening movement its distinctive ethnic flavor. Following a powerful climax each of these themes is briefly reprised. This gives way to a more introspective and subdued but expressive cadenza which ends the first movement.