Podcasts about human services hhs office

Hospitals routinely measure, analyze, and track adverse patient harm events, collecting information about and reporting on certain types of such events in order to meet the Centers for Medicare & Medicaid Services (CMS) program and state legal requirements.Prior work plans of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) revealed that hospitals reported few harm events to state reporting systems.During the next live edition of Monitor Mondays, Dr. James Kennedy, president of CDIMD, will unwrap the January 2025 OIG proposal (OEI-06-18-00401) to evaluate hospital quality reporting, suggesting how hospitals' clinical documentation integrity (CDI) and coding workflows can address errors of omission or commission.Access the OIG's announcement at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000907.asp.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: Adam Brenman, senior government affairs liaison for Zelis, will report on the latest news concerning healthcare legislation.

In this episode, Rebekah Rotstein, NCPT, joins us for a conversation about the unique health challenges women face at midlife particularly regarding bone health and osteoporosis, and ways in which women can maintain and build bone health, muscle strength and muscle strength.Rebekah Rotstein, a leading expert in Pilates, bone health, and movement education, is the founder of Buff Bones®, a medically endorsed exercise method focused on bone and joint health. Buff Bones® offers on-demand programming, online coaching, and professional training at esteemed institutions like Johns Hopkins Rehabilitation Network. With trained instructors in over 30 countries and free public education webinars through UCLA Health, Rebekah is a global advocate for bone health. She also shares valuable tips, exercises, and information through social media.Rebekah's journey began as a ballet dancer, leading her to work in the Sports Medicine department at Smith College as a student athletic trainer in 1994. She later trained and certified in the Pilates method. After being diagnosed with osteoporosis at the age of 28, she was motivated to advocate for others with low bone mass and to provide innovative education and programming.Rebekah serves on the Ambassador Leadership Council for the Bone Health and Osteoporosis Foundation (BHOF) and has partnered with the U.S. Department of Health and Human Services (HHS) Office of Women's Health. She also contributes to the Bone Health Working Group for the Society for Women's Health Research (SWHR) and co-authored the 2021 recommendations published in the Journal for Women's Health.In recent years, Pilates has significantly increased in popularity, particularly among women. This isn't a surprise, given the numerous benefits of Pilates, which include refining movement, increasing range of motion, improving breathing, enhancing flexibility, core control, balance, and even cognitive function. For many women who find traditional gyms and weight training intimidating, Pilates offers a more approachable and inclusive form of exercise. In this episode, we learn more about Pilates, the Buff Bones® program and explore its role in bone health and how it benefits individuals with osteoporosis.We can lose 3-5% of our muscle mass each decade after age 30 if we aren't active. We also loose bone mass in our early 30s and we reach our peak bone mass at age 30-35. And, once we hit menopause, we can lose 20-25% of our bone mass. So, it's important to take some action now because the lack of action is destined to lead to decline of bone mass that could potentially lead to fractures down the road.In this episode, Rebekah discusses:Tips for midlife women to maintain bone density and prevent osteoporosisExercises we can do to improve our bone health, balance and mobilityAddressing joint pain, stiffness and fascia pain through strength training and movementBenefits of somatic and internal practices and improving interoceptionSometimes, we think we're doing everything right, but still don't feel any better. Rebekah emphasizes that while Pilates is excellent for holistic health, especially for bone and muscle development, it should be complemented with other forms of exercise like cardio and strength training. Nutrition and internal balance also play important roles in overall physical and mental health. Start with activities that are enjoyable and seek professional guidance and accountability to stay consistent. These elements are vital for achieving and maintaining optimal health.Connect with Rebekah Rotstein, NCPT:LinkedIn: https://www.linkedin.com/in/rebekah-rotsteinFacebook: https://www.facebook.com/rebekah.rotsteinInstagram: https://www.i

They're looking for fraudsters, going on the prowl for bad actors, as revealed in the latest semi-annual report to Congress compiled by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). In this latest report, the government watchdog identified more than $2.76 billion in expected recoveries and receivables.Providing analysis and context for the OIG report released June 3 during the next edition of Monitor Mondays will be James S. Kennedy, MD, a subject matter expert who will review highlights and offer suggestions for remaining compliant.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 Nelson Mullins, will report the latest news about auditors.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

As if buried in shifting sands like a booby trap, Modifier 25 is poised to wreak havoc on claims when it's appended incorrectly to an evaluation and management (E&M) charge – typically to indicate a separate service on the same date of service.So, what's a provider to do? When is it actually appropriate to append Modifier 25?How do providers indicate that there was a significant yet separately identifiable E&M service that went above and beyond the typical pre- and post-work associated with the applicable procedure?And how can providers avoid a possible audit by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG)?In response to these and other questions, ICD10monitor and Talk Ten Tuesday have invited Leonta Williams, AAPC Director of Education, to serve as the broadcast's next special guest.The live broadcast will also feature these other recognizable segments:• Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, 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.• 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).• 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.

Join Ropes & Gray's attorneys for a three-part podcast series exploring recent regulatory, compliance, and enforcement developments in the fraud, waste, and abuse space and the potential implications for health care and life science companies in 2024. In this first installment, health care partners Devin Cohen and Michael Lampert discuss key considerations for understanding recent advisory opinions published by the U.S. Department of Health and Human Services (“HHS”) Office of the Inspector General (“OIG”), as well as their scope and implications. With particular focus on advisory opinions concerning beneficiary inducements to patients, this episode examines Anti-Kickback Statute and Civil Monetary Penalties Law concerns with such arrangements, as well as factors OIG has deemed to alleviate such concerns in the advisory opinions it issued in the past year. 

On part one of this two-part podcast installment, Ropes & Gray's health care partner Devin Cohen and litigation & enforcement partner Andrew O'Connor discuss the Strategic Plan for Oversight of Managed Care for Medicare and Medicaid issued in August by the Department of Health & Human Services (“HHS”) Office of Inspector General (“OIG”). Part one's discussion focuses on the first two phases of the managed care life cycle: plan establishment and enrollment and associated enforcement and regulatory actions, and OIG's compliance priorities for Medicare Advantage (“MA”) plans and how the Strategic Plan implicates regulatory and enforcement developments in the managed care space more broadly.

In this episode, Sujani sits down with Dr. Marissa Robinson, coordinator of the Ending the HIV Epidemic initiative at the US Department of Health. They discuss Marissa's education and career, her interest in HIV and the Black community's access to health, and harnessing charisma in your professional life. You'll LearnHow Marissa's personal experiences shaped her interest in the social determinants of health, specifically with HIV and the Black community's access to healthMarissa's experience at Spelman College, a historically Black college for women, and what factors she considered when making choices about educationTips on dealing with rejection, self doubt, and other barriers in your careerHow charisma is essential in leadership and public health and why it is especially important for women of colour to develop this skillToday's GuestDr. Marissa Robinson is a strategic-leader, visionary, and disruptor within the field of Infectious Disease. She focuses on HIV/AIDS research, educating the need to increase opportunities and diversity amongst the public health workforce. She currently leads as the Ending the HIV Epidemic in the U.S. (EHE) initiative Coordinator at the US Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health within the Office of Infectious Disease and HIV/AIDS Policy.Dr. Robinson is a DMV native and is trained in infectious disease epidemiology. She has conducted extensive HIV/AIDS research for over a decade. She began her federal career when she joined the United States Peace Corps as a Community Health and Malaria Prevention volunteer in Togo, West Africa. After returning to the US, Dr. Robinson worked at the Health Resources and Services Administration (HRSA) in the HIV/AIDS Bureau (HAB) on global infectious disease surveillance supporting the President's Emergency Plan for AIDS Relief (PEPFAR) initiative. Following her time at HRSA, Dr. Robinson joined the Centers for Disease Control and Prevention (CDC) where she conducted and maintained data analytics for a Nursing and Midwifery initiative on behalf of PEPFAR for 13 African countries. After her time at CDC, Dr. Robinson joined the CDC Foundation on the Teens Linked to Care pilot program with the CDC's Division of Adolescent and School Health which focused on substance use and sexual risk among youth in rural populations.Dr. Robinson completed her Doctor of Public Health degree as a Goldseeker Scholar at Morgan State University's School of Community Health and Policy. Her dissertation was entitled “A Qualitative Exploration of Preexposure Prophylaxis Among Black Women Attending a Historically Black College and University in the Northeastern United States”. Dr. Robinson completed her doctoral fellowship training at Johns Hopkins School of Medicine Pre-Doctoral Clinical Research Training Program. Dr. Robinson received her Master of Public Health with a concentration in global health, infectious diseases, and a certificate in socio-contextual determinants of health from Emory University's Rollins School of Public Health and her Bachelor of Arts in psychology and public health from Spelman College.ResourcesFollow Marissa on LinkedIn or Twitter or send her an email Learn more about Spelman College Listen to The "It" FactorSupport the showJoin The Public Health Career Club: the #1 hangout spot and community dedicated to building and growing your dream public health career.

Healthcare organizations often face staffing shortages in their revenue cycle, adding to the pressure of ensuring proper claims processing. The Centers for Medicare & Medicaid Services (CMS), U.S. Department of Justice (DOJ), and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) have increased audits to reduce improper payments, using predictive modeling and artificial-intelligence (AI) tools. Risk-based audits rose by 28 percent and prospective audits by 32 percent in 2022.To ease the burden on revenue cycle management (RCM) teams, a combination of automation, analytics tools, and denial management software can be used for hybrid audits, reducing denials and increasing reimbursements. During the next live edition of Monitor Mondays, Ritesh Ramesh, CEO for MDaudits, will report on how, by leveraging people and technology, internal audits can be conducted faster, errors caught earlier, and staff can focus more on training and optimizing revenue.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday rounds.The RAC Report: Healthcare attorney Kyla Wonder, 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 officer for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

April is Minority Health Month, and the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) observes National Minority Health Month to highlight the importance of improving the health of racial and ethnic minority and American Indian/Alaska Native (AI/AN) communities and reducing health disparities. The theme for National Minority Health Month 2023 is "Better Health Through Better Understanding", focuses on improving health outcomes for racial and minority communities by providing them with culturally and linguistically competent healthcare services, information, and resources. As we think about eliminating health disparities, a part of that is making sure we are empowered as individuals to be advocates for ourselves. While we work on changing policies, we also have to make sure we are educated about our bodies, our minds, and our daily habits. Listen in to this conversation with Sandra Jenkins Clark, a certified yoga instructor and Dr. Nicholette Martin, a health and wellness coach and author, and former National Director, Health and Human Services for The Links, Incorporated - to give you some tips on the benefits of yoga, some commonly asked nutrition questions, and the importance of self-care.

In this episode, host Raghu Nandakumara and Gerald Caron, Former Chief Information Officer for the Office of the Inspector General at the US Department of Health and Human Services, unpack how to manage operational risk, the role of data mapping in any successful Zero Trust strategy, and demonstrating ROI. --------“Because when you're managing risk, it's not just an IT thing. It's also a mission thing as well. What are the political aspects of the risk and the decisions that you're making? That informs the IT risk as well. But I think it has to be well understood that this is, going back to the ROI, this is why this is a good investment. This is gonna help mitigate this risk… [Zero Trust] is a cultural thing for an organization and it needs to be communicated.” - Gerald Caron--------Time Stamps* (5:00) Understanding your operational risk posture as a CIO* (9:52) What peanut butter, the cinema and Zero Trust have in common* (14:10) Demystifying Zero Trust: Driving the adoption of ZT at the OIG* (18:40) Measuring progress and effectiveness* (25:53) Aligning Zero Trust with your company's business strategy--------SponsorAssume breach, minimize impact, increase resilience ROI, and save millions in downtime costs — with Illumio, the Zero Trust Segmentation company. Learn more at illumio.com/--------LinksConnect with Gerald on LinkedIn

In May 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a report claiming that 25 percent of Medicare patients experienced adverse events during their October 2008 hospital stay.“That's a staggering number,” said John K. Hall, MD, in an email to RACmonitor. “So, what does it mean, and what should providers expect from other auditors and government agencies?”During the next live edition of Monitor Mondays, physician and attorney Dr. Hall will review the report and offer suggestions to prepare if the OIG comes knocking at your door.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: Matthew Albright, chief legislative affairs officer 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.

We've all watched in awe as the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) began investigating the Medicare Advantage plans. Many were thinking, “it's about time the payers get some of the heat providers feel.” But there's something even better, according to most. That's when the OIG investigates the government.During the next live edition of Monitor Mondays, physician-attorney Dr. John K. Hall reviews an OIG audit of Medicare contractors and the Centers for Medicare & Medicaid Services (CMS). He'll also explain what this means for providers.Other segments will include these instantly recognizable broadcast features: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.

Most healthcare providers are swimming in shark-infested waters these days, ever-watchful for dorsal fins that signal imminent danger.  At first there were the Recovery Auditors (RAs), created by the Centers for Medicare & Medicaid Services (CMS), to correct Medicare billing submitted by providers for services rendered to Medicare beneficiaries. And now, nearly two decades later, the RAs have been joined by several other auditors, and healthcare has quickly become a dangerous and expensive environment, especially given a new breed of sharks: the Medicare Advantage Organizations (MAOs), whose primary mission is to save money by denying claims in the name of compliance.Join us next Monday for another live edition of the long-running Monitor Mondays Internet broadcast for a news round-up, and to learn of more lurking dangers and how to protect your facility's revenue while remaining compliant, even amid all the turmoil.Other segments will include these instantly recognizable broadcast features:OIG Report: Monitor Monday's own physician and attorney, Dr. John K. Hall, will report on the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) audit of critical care billing at Leahy Clinic in Boston. If you have an ICU, you will need to hear his report.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: Marie Stinebuck, COO of Phoenix Medical Management, Inc, 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: Adam Brenman, Federal Legislative Analyst for Zelis, will report on current healthcare legislation.

DRG validation denials by Medicare Advantage (MA) plans have become a widespread and increasing concern for many hospitals.But these denials may be the result of a misapplication of standard diagnostic criteria by a reviewer. Now, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is turning the DRG validation denials back on MAs. The OIG recently published several diagnosis-validation audits of MAs and recommended recoupment for exactly the same diagnoses the MAs have denied for providers.But what can we learn from these audits to help manage diagnosis denials by payers? Does this portend new MA tactics? Sitting in for Dr. Ronald Hirsch during the next edition of Monitor Mondays will be our own physician and attorney, Dr John K. Hall, who will offer his take on the future of diagnosis denials and how to prepare.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; andLegislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

The warning was shot across the bow of Medicare Advantage Organizations (MAOs). The U.S. Department of Health and Human Services (HHS) Office of Inspector (OIG), in a report to the Centers for Medicare & Medicaid Services (CMS) raised concerned that MAOs could be denying prior authorizations requests in an attempt to increase profits.CMS agreed to the report and, on Aug. 3, issued new guidance on the appropriate use of MAO clinical criteria for medical necessity reviews along with numerous revisions.Reporting on this developing story during the next live edition of Monitor Mondays will be Dennis Jones, administrator of patient financial services for Montefiore Nyack Hospital.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: Substituting for Matthew Albright, will be Cate Brantley, legislative affairs analyst for Zelis. Brantley will report on current healthcare legislation.

Nearly $3 billion in expected recoveries have surfaced in the spring 2022 Semiannual Report to Congress by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). As reported by RACmonitor's Mark Spivey, the OIG report also provides an overview of the watchdog's activities from Oct. 1, 2021 through March 31, 2022. During the next live edition of Monitor Mondays, providing comment and context to the report, which was published Monday, June 6, will be prominent healthcare attorney Andrew “Drew” Wachler, a longtime OIG observer and the managing partner at Wachler and Associates. 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.  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. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment. 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: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

With the growth of Medicare hospice services comes expanded oversight on claims and care quality. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has initiated a nationwide audit of hospice claims on the heels of multiple in-depth audits of such facilities. Unified Program Integrity Contractors (UPICs) and Medicare Administrative Contractors (MACs) have joined the hunt in recent weeks, putting all hospices on notice that vigilant compliance measures are essential. At the same time, there have been increased survey frequency and expanded sanction risk targeting these providers – and all of this will be part of the coverage of our lead story during the next Monitor Mondays broadcast.  Other segments will include the following:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs). 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.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.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: Folana Houston, assistant general counsel at Zelis, will be substituting for Matthew Albright, chief legislative affairs officer for Zelis, and will report on current healthcare legislation.

Additional resources OHA COVID-19 vaccine website: covidvaccine.oregon.gov OHA Facebook  Safe+Strong website Ask a Black Doctor on The Numberz REACH webpage and REACH Facebook Treatments for COVID-19 Q1: I have heard that some people can get treated for COVID-19. What treatments are available and how are they different from vaccines? Yes – treatments for COVID-19 are available for some people. Some treatments are given in the hospital, some are infusions and some are pills you can take at home. They are all in short supply and currently available to people who are high risk of severe disease.  Vaccines introduce your immune system to a protein from the virus, allowing you to build up antibodies without being infected. Vaccination can also boost any natural immunity a person may have from being previously infected.  When somebody with sufficient antibodies is exposed to COVID-19, they immediately fend off the virus, which prevents infection. As antibody levels drop, the virus may be able to infect the person but the immune system still has a decent chance to fight COVID-19 and prevent severe infection.  Booster shots rebuild antibodies quickly, within a few days, even quicker than the original vaccination. This rapid rebuild also happens when an unvaccinated person previously infected with the COVID-19 virus gets their first vaccination. So be sure to get vaccinated and boosted, even if you have previously been infected with COVID-19. Treatments do not replace vaccination, which remains the most important step we can take to protect ourselves and our loved ones.  If someone can't get vaccinated, there is a treatment available that helps the body fight the virus that causes COVID-19.  Treatment for COVID-19 must take place shortly after someone has tested positive. If you've tested positive for COVID or have symptoms, contact your doctor right away. Q2: Someone was telling me about the federal Test to Treat program. Is this a program for everyone? The Test to Treat program connects people that are at high risk of severe illness from COVID-19 with the right treatment. It provides people a place to go to get tested, receive a prescription for a treatment, and fill that prescription all at one location. The program is intended for people that do not have a doctor or who cannot easily get in to see their doctor. However, anyone can receive treatment at a Test to Treat site. To participate, a person can use the Test to Treat Locator to find a site, or call 1-800-232-0233. These sites receive their therapeutics from the federal government. OHA is working on adding additional sites that fit federal criteria to be a Test to Treat site.   Q3: If treatments support defense against COVID-19, why aren't they available to everyone? There a few reasons why treatments are not available to everyone. First, vaccines have proven to be the best defense against COVID-19. Get vaccinated and then boosted. Also, don't forget your flu shot. Secondly, because of nationwide shortages, treatments are not widely available. Finally, it is all based on eligibility. A healthcare provider determines eligibility based on your medical profile. They will consider things like if you cannot get vaccinated due to health conditions or if you had a bad reaction to the vaccine or if you need additional treatment due to a weakened immune system. Only a healthcare provider can assess if you are eligible. Q3: Are treatments safe?  Depending on your medical history, certain treatments are not recommended. To determine which treatment is right for you, consult your doctor. You should also always check that your information is from a trusted source. If you have questions about any medication, contact the FDA's Division of Drug Information at 301-796-3400 or druginfo@fda.hhs.gov. Q5: What are the names of the FDA approved or authorized treatments and once I take them, how do they work in my body to fight COVID-19? The FDA has authorized two oral antiviral medications, one from Pfizer named Paxlovid. The other from Merck named Molnupiravir. With either one, they must be taken as soon as possible after a positive COVID-19 test and within the first five days of symptoms to be effective.  Paxlovid works by stoping the replication of the COVID-19 virus in the body by binding to an enzyme that disrupts the virus' ability to mutate and keeps certain viral proteins from forming correctly.   Molnupiravir interrupts replication of the virus' genetic material by introducing mutations. As the virus copies itself, it gets so mutated that it can no longer function.   The same thing happens with the FDA approved antiviral drug Remdesivir, known as Veklury, it also acts on the virus' genetic material, blocking its ability to mutate. It is administered by injection into the vein through an IV. Monoclonal antibodies (mAbs) are authorized for use to treat COVID-19. They work by mimicking the antibodies your body produces in response to a virus. These molecules are produced in a laboratory and they work to block the COVID-19 virus from entering your cells. Monoclonal antibody treatment is a fluid given using a needle either into a vein (infusion) or under the skin (subcutaneously). Your healthcare provider or the site where you will be getting treatment will explain which treatment you will get. For both procedures, needles are used by a trained medical professional. If you are unvaccinated, you should wait 90 days after your treatment to get the vaccine. Regen-Cov, Sotrovimab, Bebtelovimab and Evusheld are all monoclonal antibodies. Sotrovimab is effective against infection by the  Omicron variant.  Q6: Finally, April is National Minority Health Month how can I get involved? This year the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) and its partners are highlighting the important role community plays in helping to reduce health disparities in racial and ethnic minority and American Indian/Alaska Native groups. The theme for this year is Give Your Community a Boost!  To support COVID-19 vaccination and boosting, OMH invites you to #BoostYourCommunity by using, sharing, and attending National Minority Health Month (NMHM) resources and events with your organization, communities, and network!  If you are not insured, you might qualify for the Oregon Health Plan, which covers COVID-19 vaccines, boosters, treatment and home tests. It also covers regular check-ups, prescriptions, mental health care, addiction treatment, dental care and more. To see if you qualify and to learn more go to OHP.Oregon.gov and click Apply for OHP. You can also call 800-699-9075 or find a local community partner at bit.ly/ohplocalhelp for help.Document accessibility: For individuals with disabilities or individuals who speak a language other than English, OHA can provide information in alternate formats such as translations, large print, or braille. Contact the Health Information Center at 1-971-673-2411, 711 TTY or COVID19.LanguageAccess@dhsoha.state.or.us.

With Medicare audits looming and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan items now relating to telehealth services performed during the COVID-19 public health emergency (PHE), it is time to make certain that your organization is accurately reporting services and claims within the requirements of the 1135 waivers relevant to the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020.  Remember, too, that in the world of healthcare auditing, it's not “if” you get audited, but “when.”Because of the immediacy of these Medicare telehealth audits, we asked nationally recognized professional auditor, coder, author, and consultant Terry Fletcher to share with you the top 10 regulatory rules for Medicare telehealth.The live broadcast will also feature these other segments:Tuesday Focus: Outpatient CDI Update: The Hospital Outpatient Quality Reporting Program evaluates the regularity of treatment known to provide the best results for certain conditions. Colleen Deighan, a consultant with 3M, will return to provide details on quality measure 40, which reports the percentage of emergency department patients with a diagnosis of ST-segment elevation myocardial infarction (STEMI) who received appropriate treatment within specific time frames upon arrival to the emergency department.Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will report on the latest coding news.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington, D.C.News Desk: John Zelem, MD, FACS, founder and CEO for Streamline Solutions Consulting, will anchor the Talk Ten Tuesdays News Desk.Sitting in for Dr. Erica Remer will be Susan Gatehouse, founder and CEO for Axea Solutions.

Welcome to The Endow Podcast! This podcast is a forum for women to foster conversations about the intellectual life and intentional community for the cultivation of the feminine genius.On this episode, Simone Rizkallah, Director of Program Growth, interviews Louis Brown on healing, evangelizing, and getting outside your comfort zone. Louis Brown received an undergraduate degree from Michigan State University and a Juris Doctorate from Howard University School of Law. After law school, he first worked as a private practice attorney for a firm where he practiced labor law and commercial litigation including representing, second chair, a major municipal employer in its labor arbitrations with police unions. He later served as associate director of social concerns, for a state Catholic conference where he advocated for the unborn, the materially impoverished, and immigrants at the state legislature. In 2014, Brown joined the Christ Medicus Foundation (CMF), a Catholic health care nonprofit whose mission is to share the healing love of Jesus Christ through defending religious freedom and making Catholic health care accessible to the poor and most vulnerable. In 2017, Brown began serving at the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. During his time at HHS, Brown enforced vital federal civil rights laws to protect and defend the civil rights of patients and human service recipients. Brown returned to CMF in 2019 and serves as its Executive Director.  Thanks for listening! Vatican link to the document: https://www.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20131124_evangelii-gaudium.html Support the Endow PodcastWhat's on your mind and heart? Let our host, Simone Rizkallah, know by connecting with her and The Endow Team on social media!Facebook at www.facebook.com/endowgroupsInstagram at www.instagram.com/endowgroupsWant to start your own Endow Group? Learn more by visiting our website at www.endowgroups.org or reach out to us at info@endowgroups.org. We look forward to serving you!

Public schools and facilities will be closed. Church bells will chime, while a number of flags will fly at half-mast.  Because in 1983, former Republican President Ronald Reagan proclaimed that the third Monday of January would forever be observed as Martin Luther King Jr. Day.This coming Monday, Jan. 17, Monitor Mondays will honor the slain civil rights leader with a special report recognizing efforts by various stakeholders to advance a variety of initiatives designed to improve health equity in America.Reporting on how communities of color can benefit from regulatory efforts by the Centers for Medicare & Medicaid Services (CMS) and related federal agencies will be Lenel James, a business lead for Health Information Exchange & Innovation for the BlueCross and BlueShield Association (BCBSA). Mr. James was formerly associated with the Region V Regional Health Equity Council of Department of Health and Human Services (HHS) Office of Minority Health. In addition, he previously served on the Board of the Cosmopolitan Chamber of Commerce in Chicago, the second largest African American Chamber of Commerce in the US.Other segments to be featured during the live broadcast include the following:Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.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.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 the healthcare regulations and the SDoH.

We're taking AIM at reducing maternal morbidity and mortality during an exclusive four-part series on ICD10monitor and Talk Ten Tuesdays. The series will be led by senior healthcare consultant Kristi Pollard, Director of Coding Quality and Education for the Haugen Consulting Group. During her series, Kristi will discuss how coded data is being used by the Alliance for Innovation on Maternal Health (AIM) to improve maternal outcomes. The live broadcast will also feature these other segments: Special Report: American Health Information Management Association (AHIMA) 2021 President and Chair Katherine Lusk will discuss accomplishments from her term and how the Association continues to advance and advocate for the creation and use of trusted information. The Coding Report: Laurie Johnson will report on the latest coding news. Tuesday Focus: Telemedicine or Telemarketing: Former special agent for the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Eric Rubenstein will report on how fraud, currently being perpetuated against the Medicare population, is best defined as “telemarketing” fraud. Rubenstein is now director of litigation for Advize Health, LLC.  News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, 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. 

Lawmakers are lining up to decide what Medicare will pay for after the COVID-19 public health emergency (PHE) is over – and they are looking confident that they have the votes to include it in a must-pass piece of legislation this year.Congress also seems to be on board with a plan to allow millions of Medicare patients to continue to video-chat with their physicians once the PHE is over. The Medicare advisory committee, MedPAC, has recommended a cautious approach, however, that would temporarily cover some telehealth services for all beneficiaries, but revert to lower reimbursement rates post-crisis for virtual appointments compared to in-person. There's also concern that a rapid expansion could prompt more fraudulent billings: the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) estimates that $4.5 billion in telehealth-related fraud was lost last year, which is why Part B evaluation and management (E&M) services provided during the PHE is on the current OIG 2021 Work Plan.Nationally recognized physician auditor, educator, and coder Terry Fletcher will report on this developing story 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 have the Talk Ten Tuesdays Coding Report, along with the broadcast's weekly Listeners Survey.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, 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.

Are you monitoring the 2021 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan? The watchdog agency is watching you. They're auditing claims for evaluation and management (E&M) services performed on the same day as minor surgical procedures that have been documented with Modifier 25. The backstory: in 2019, about 56 percent of dermatologists' claims with an E&M service also included minor surgical procedures (such as lesion removals, destructions, and biopsies) on the same day. This may indicate abuse, wherein the provider used Modifier 25 to bill Medicare for a significant and separately identifiable E&M service when only a minor surgical procedure and related preoperative and postoperative services were supported by the beneficiary's medical record. Nationally recognized professional coder, educator, and auditor Terry Fletcher will return to the Talk Ten Tuesdays broadcast for its next edition to report the lead story. The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC, will have the Talk Ten Tuesdays Coding Report, along with the broadcast's weekly Listeners Survey. Tuesday Focus: Homework: Many auditors and coders are working from home these days, and home has raised new obstacles and some new advantages to our daily routines. How to bring the home practicality into the coding and auditing work world will be Shannon DeConda, founder of the National Alliance of Medical Auditing Specialist (NAMAS). News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.Point of View: Dennis Jones, Patient Financial Services Administrator at Montefiore Nyack Hospital, will substitute for co-host Erica Remer, MD.

“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.

They’re using text messages. They’re offering vaccination cards, and even COVID-19 testing. They’re scammers.The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is currently warning that providers that charge impermissible fees must refund them, and ensure that individuals are not charged any sum at all, for the COVID-19 vaccine – along with warning of fraudulent telemarketing calls and even door-to-door visits. Of particular concern are scammers pretending to be COVID-19 contact tracers.“Legitimate contact tracers will never ask for your Medicare number or financial information, or attempt to set up a COVID-19 test for you and collect payment information for the test,” the OIG notes on its website.Just how prevalent are these scams? Reporting our lead story during the next live edition of Monitor Mondays will be RACmonitor investigative reporter Ed Roche, who was among the very first to report on contact tracers during the early stages of the pandemic, here on Monitor Mondays and RACmonitor.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.

Healthcare data breaches and the possibility of sanctions from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) are a rightfully terrifying possibility for healthcare administrators.But one hospital, MD Anderson Cancer Center, recently fought back and won. Reporting on the outcome of the decision handed down by the 5th Circuit Court of Appeals during the next live broadcast of Monitor Mondays will be Dr. John K. Hall, a physician and attorney. Hall, founder of the Aegis Group, will provide an analysis of the case, while offering valuable lessons that can be learned from it.Other segments to be featured during the live broadcast include the following: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 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 report the Monitor Mondays lead story.

To ensure compliance in conveying device credits and to identify providers who do not, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has a specific Annual Work Plan item to address the matter.Either through targeted device credit audits or enveloped in broader general billing compliance regulations for hospitals and ambulatory surgical centers (ASCs), the OIG is clearly seeking to ferret out “noncompliers.” Adding fuel to the fire, the OIG also has a related Work Plan item based on device credits already reported, but done improperly: outpatient outlier payments for claims.Reporting our lead story during the next edition of Monitor Mondays will be Michael G. Calahan, PA, MBA, AHIMA-approved ICD-10-CM/PCS trainer and vice president of hospital and physician compliance with HealthCare Consulting Solutions (HCS). Calahan will also reveal five critical mistakes providers often make in trying to comply with these stringent rules.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 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.

There has long been a focus on improving documentation for the purpose of maximizing the capture of complications and morbidities and major complications and morbidities (CCs and MCCs). As value-based purchasing is becoming more widely adopted, the importance of improving documentation is becoming more relevant. Case in point: the importance of coagulopathy documentation and its impact on perioperative hemorrhage and hematoma, a patient safety indictor (PSI-9).Reporting our lead story during the next edition of Talk Ten Tuesdays will be Dr. Ahmed Abuabdou, Associate Chief Medical Officer and Associate Professor of Medicine at the University of Arkansas for Medical Sciences (UAMS) Medical Center.The live broadcast will also feature these other segments:Tuesday Focus: Telehealth: The proliferation of telehealth, now identified in the 2021 U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan, means that you will need to be extra diligent when coding the service in order to be compliant, according to Terry Fletcher, nationally recognized professional auditor and coder, who will return to the broadcast to report on the topic with a focus on audio-only check-ins.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.

The next upcoming Monitor Mondays broadcast will encompass a special live open-door forum, coming at the intersection of compliance and the coronavirus – a jarring combination, in light of the fact that the continuing viral pandemic has claimed the lives of more than 250,000 and infected more than 11 million in the U.S.It is here, at this critical point, that providers are reconciling a patchwork of regulatory waviers while addressing the urgent need of helping patients in their struggle to survive. Adding a layer of complexity is the spectre of audits and the ever-watchful eye of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG).In recognition of the confusion, the next edition of Monitor Mondays will also be extended to 60 minutes, allowing for questions and answers.Other segments to be featured during the live broadcast include the following:OIG Report: RACmonitor investigative reporter Edward Roche will report on the latest move by the OIG that faults Medicare contractors for being inconsistent in their review of extrapolated overpayments amid the appeal process.COVID-19: Frontline physician John Foggle will return to the broadcast to provide a real-time update on the raging spread of the coronavirus – at a time of widespread holiday travel for Thanksgiving.Special Report: Andrew Dombro, MD will report on the impact of COVID-19 on providers and patients engaged in chronic care management.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: Attorney Ashley Thomson, 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.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.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently closed in on more than 345 defendants charged with participating in scams involving more than $6 billion in alleged losses to federal healthcare programs.The takedown occurred in September, according to the OIG. Of that amount, approximately $4.5 billion was associated with telemedicine schemes. The action by the feds puts a spotlight on the growing use of telehealth as a consequence of the ongoing coronavirus pandemic.Reporting our lead story during this edition of Monitor Mondays is John K. Hall, an attorney and physician.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 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, joins 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, makes his Monday Rounds with another installment of his popular segment.

Never before has the responsibility of an organization to provide clear, facility-specific guidelines and in-depth training for coders been more apparent than it is today – especially now with the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) poised to conduct diagnosis-related group (DRG) validation audits. Reporting our lead story during this edition of Talk Ten Tuesdays will be Cari Greenwood who will discuss how your team should intensify training –- particularly when it comes to assigning correct codes for high-frequency, problem-prone, and high-cost diagnoses.Other segments to be featured on the broadcast include:News Desk: 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.RegWatch: Leading healthcare technology consultant Stanley Nachimson returns with his popular segment, RegWatch, through which he reports on the latest regulatory changes coming out of Washington, D.C.Tuesday Focus: The Office of Disease Prevention and Health Promotion (ODPHP), on behalf of the Federal Interagency Steering Committee for Adverse Drug Events, recently released its final version of the National Action Plan for Adverse Drug Event Prevention (ADE Action Plan). Reporting on this developing story will be Ronald Hirsch, MD, vice president of R1 Physician Advisory Services.CDI Report: ICD10monitor contributor Glenn Krauss continues his reporting on clinical documentation integrity, but this time, he will focus on the recent decision by HHS OIG to conduct DRG validation audits.TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on an issue that recently caught her attention during her popular TalkBack segment.

Are you experiencing this dilemma at your facility? You ask your physicians to add linking verbiage to their documentation for accuracy, which in turn has a negative impact on their publicly reported scores regarding complications and other metrics. Should physicians exclude the linking verbiage? Should they enter “as expected,” or should they simply avoid addressing these issues? Reporting on this complex issue during the next edition of Talk Ten Tuesdays will be Sharon Savinsky, clinical documentation improvement specialist (CDIS) team manager at Winchester Medical Center in Winchester, Va.Other segments to be featured on the broadcast include:News Desk: Laurie Johnson will anchor the Talk Ten-Tuesdays News Desk. Johnson is a senior healthcare consultant with Revenue Cycle Solutions, LLC and an ICD10monitor contributor. Coding Report: Although the Centers for Medicare & Medicaid Services (CMS) has released the final rule on the 2019 Medicare Physician Fee Schedule (MPFS), Dr. Jeffrey Lehrman will report on one issue that CMS did not include in its extensive update.Tuesday Focus: Alarms are being sounded because of the clinical and privacy issues being raised as a result of offshore coding. Terry Fletcher, a nationally recognized professional physician coding consultant, educator and auditor, will report this developing story.TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., will report on the recent decision by U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to conduct DRG validation audits.

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.

UnitedHealthcare (UHC) is putting providers on notice: Come Jan. 1, 2019, the industry giant will use the SEP-3 definition to determine if a diagnosis of sepsis is clinically validated, advising that the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score is to be used to determine if sepsis is present.   If reviewers find no SOFA score in the medical record, that could spell trouble – audit trouble. Reporting on this topic during this edition of Monitor Mondays is Edward Hu, MD, executive director of Inpatient Physician Advisor Services for the University of North Carolina Health Care System and president of the American College of Physician Advisors. The broadcast rundown also will include: The RAC Report: Healthcare attorney Knicole Emanuel reports on a flurry of new cases in which judges are ordering the government to refrain from recouping alleged overpayments until a hearing has been held. Immediate recoupments, currently allowable by law, fundamentally violate our country’s concept of due process. Medicare Advantage Report: A recent investigation by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that Medicare Advantage plans overturned 75 percent of their denials. Timothy Powell, Monitor Monday national correspondent, reports on this developing story. Rural Health Report: There has been a spike in the closure of rural hospitals, according to the Government Accountability Office (GAO). In a recent report, the GAO says that a total of 64 rural hospitals closed between 2013 and 2017. In the face of that bad news, Leslie Marsh, the chief executive officer for Lexington Regional Health Center in Lexington, Neb., reports on the positive economic impact her facility is having on the community. 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. Monitor with us™

Should total knee replacements (TKRs) be performed as inpatient or outpatient procedures? Some facilities are admitting all of them as inpatient while other facilities take a more conservative approach to admission. How are TKRs being handled at your facility? Mary Beth Pace, vice president of care management at Trinity Health and the special guest on this edition of Monitor Mondays, frames the conundrum as a hypothetical patient/caregiver conversation: "we are going to do major surgery on you, but we are not sure if we will keep you after surgery – and oh, by the way, there will be a copay and deductible either way, we don't know which one. But don't worry, it will be a good thing to have your knee in working order again." Tune in to the podcast as she reports on how TKRs are admitted at Trinity. Also reporting on this timely subject is Jeffrey Pilger, MD, a board-certified lead physician advisor affiliated with St. Elizabeth Healthcare Edgewood in Edgewood, Ky. 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. Office of Civil Rights Report: Rita Bowen, with MRO, is a nationally recognized healthcare privacy expert. Bowen reports on the latest initiatives by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), including updates on the HIPAA Audit Program, patient access guidance, and resolution agreements. 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. Prior Authorization: Betty Lengyel-Gomez with the Healthcare Administrative Technology Association (HATA) reports on research HATA has conducted to remove barriers to the adoption of prior authorization transactions. Lengyel-Gomez is the industry relations and regulatory compliance director for MedInformatix. Monitor with us™