Podcasts about Medical necessity

During the next edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will provide an update on a whistleblower case that some consider “beyond bad.”You'll learn why a Texas rheumatologist who was sentenced to 10 years in prison and three years of supervised release was ordered to forfeit more than $28 million, plus 13 real-estate properties, a jet, and a Maserati GranTurismo sports car.Inman, long considered one of the nation's foremost whistleblower attorneys, will be the program's special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, June 2, 2025.The long-running 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.Field Report: Drew Updike will continue his reporting on efforts by the Trump Administration to intervene in healthcare issues – namely the Centers for Medicare & Medicaid Services (CMS) Form 64 related to migrants and Medicaid.

Welcome to a strange new world.Recent tariffs announced by the Trump Administration are likely to impact drug manufacturing, since many drug components are produced outside the U.S., in nations such as in India, giving rise to state laws. Many states limit overseas involvement relative to the Health Insurance Portability and Accountability Act (HIPAA). Florida, for example, prohibits the offshoring of certain patient data, requiring such storage to be within the U.S.Responding to this emerging crisis, the producers of RACmonitor and Monitor Mondays have invited Lexi Morrison, director of operations at MedPharma, to be the program's special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, May 19.The long-running 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 analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

On the surface, it was the perfect scam: kickbacks to docs in exchange for public speaking engagements, in order to induce them to prescribe drugs.That's apparently what Gilead Sciences thought.But a whistleblower blew the whistle, and Gilead admitted to paying hundreds of thousands of dollars to high prescribers of their HIV drugs to serve as speakers at programs at luxury restaurants.Famed whistleblower attorney Mary Inman, partner at Whistleblowers Partners, LLP, will report the savory details during the new live edition of Monitor Mondays, coming up at 10 a.m. EST on Monday, May 12.The long-running 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: Folan Houston, assistant general counsel for Zelis, will report on the news at the intersection of healthcare and congressional action.• Field Report: Dr. Drew Updike continues his reporting on recent efforts by the Trump Administration to prevent providers from undertaking gender-affirming treatments for America's LGBTQ+ population.

The 2021/2023 E/M guideline revisions read: “The evaluation and/or treatment should be consistent with the likely nature of the condition.” Before this, the CPT® guidelines did not discuss medical necessity. Guidance was left to the payers, particularly Medicare, via the Social Security Act. CMS's guidance doesn't necessarily hold regulatory authority. However, it often reflects a new, shared […] The post Medical Necessity Comes Before Coding appeared first on Terry Fletcher Consulting, Inc..

Once again, the venerable 340B Drug Pricing Program finds itself in the crosshairs of critics – this time, from the U.S. Congress.Recently, Sen. Bill Cassidy (R-La.), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a report outlining his office's investigation into the program.During the next live edition of Monitor Mondays, 340B Health CEO Maureen Testoni will return to the broadcast to offer her response to the senator's investigation.The long-running 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 healthcare government affairs analyst for Zelis, will report on the news at the intersection of healthcare and congressional action.

Today we hear from Molly and Sam. What an amazing team they were. They share with us their experience of doing the practices and getting the mind on board. Sam was able to hold space for Molly who had a very short birth, ultimately a water birth. Her daughter had to have some extra help breathing, and be taken to NICU, but they were able to handle it really calmly, through having a pre determined plan. This story is really a great example of how intense situations can be handled with the right preparation. Lots of wonderful wisdom again for you this week - enjoy!   Links: Transform Parenting website Transform Your Birth Today Better Birth: Mini Gift Free resource: Medical Necessity vs Choice

Nearly every day, on any news service, images of people being quickly led away is chilling as the current Administration continues its sweep of rounding up and deporting suspected illegal immigrants.Thus, in this current climate of increased audits, investigations and scrutiny on immigration, it is essential that healthcare organizations sponsoring foreign nationals for employment, ensure that documentation, policies, and practices are updated and fully compliant.During the next live edition of the venerable Monitor Mondays live Internet radio broadcast, seasoned immigration attorney Matthew Webster will walk you through such essential issues as H-1B visas, L-1 visas and employment-based green cards. Webster is also expected to report on requirements from the Department of Labor (DOL) and the United States Citizenship and Immigration Services (USCIS).Webster, senior immigration attorney at the law firm of Fredrikson & Byron, will discuss the impact of material changes when H-1B amendments are required.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• 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 congressional action taking place in Washington, D.C.

The fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) proposed rule introduces significant reforms to hospital reimbursement, risk adjustment, and performance measurement.Key changes include the Centers for Medicare & Medicaid Services (CMS) transition to HCC Version 28, the use of the Community Deprivation Index (CDI) for socioeconomic risk adjustment and expanded inclusion of Medicare Advantage data in quality metrics.Launching in 2026, the proposed rule mandates episode-based payments with enhanced pricing accuracy. Hospitals must adapt by updating financial models, realigning quality strategies, and fostering cross-departmental collaboration. These changes emphasize equity, accountability, and transparency, all of which is designed to help in the positioning hospitals to lead in a value-driven healthcare environment.Strategic readiness is critical to thrive under IPPS 2026. Reporting this story, during the next live edition of Monitor Mondays, will be the broadcast's special guest Penny Jefferson.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• 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: Folana Houston, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• News Update: Dr. Drew Update will have an update to his recent reporting on transgender treatment practices.

Cara had a pregnancy where she experienced constant nausea and wanting to vomit. As a result, she didn't have much confidence in herself to birth her baby and was considering an elective caesarean. After completing the ‘Transform Your Birth,' course, she had a complete shift in her thinking, and started to entertain the idea that she could give birth to her baby. Liam also started to realise the important role he could play and they both did the practices together. Her labour started with waters breaking, and ended in a very efficient and quick labour. We also discuss how her birth experience has influenced her confidence when parenting. Some fabulous wisdom to share. Enjoy!   Links: Transform Parenting website Transform Your Birth Today Better Birth: Mini Gift Free resource: Medical Necessity vs Choice

A flurry of national news reports continues to document the large-scale restructuring taking place at the U.S. Department of Health and Human Services (HHS), where 10,000 jobs were reportedly slashed earlier this month, a move also impacting the workforce at the Centers for Medicare & Medicaid Services (CMS). An estimated 300 CMS workers are expected to be affected by this action, while NPR reported that the HHS teams focusing on sexual violence prevention were also eliminated – on the first day of April's Sexual Assault Awareness Month.Also recently, RACmonitor and Monitor Mondays have come into possession of a CMS memo, dated March 5, in which the agency warns that it may take action to prevent hospitals and other providers suspected of using “dangerous chemicals and surgical mutilation of children” relative to gender dysphoria, which the agency claims have “proliferated.” In fact, other executive actions taken by the Trump Administration also appear to have anticipated deleterious impacts on the health of America's LGBTQ+ population.It seems part of an overarching theme in which the Administration is waging social wars using gutted federal agencies more as a weaponized tactic than as a mechanism to serve the public.Reporting this story during the next live edition of Monitor Mondays will be physician Drew Updike, a recognized leader in hospital utilization management, denials, clinical documentation integrity (CDI), coding, and hospital operations.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. Shaemarke Magan, medical director for CaroMont Health in Gastonia, North Carolina, will make his Monday rounds, substituting for Dr. Ronald Hirsch.

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.

Caitlin had a history of mental health challenges. Through the support of her GP, was able to access the right people through the hospital and community to set in place support that enabled her to feel more relaxed about giving birth. She also prepared with yoga and the ‘Transform Your Birth,' course that enabled her to access her own inner calm - which as an anxious person helped enormously on the day. She chose to be induced when her blood pressure was considerably high. She shares with us some great strategies that she used to support her inner calm, from affirmations to tools her partner offered to find comfort. Her birth was a wonderful experience which caused her to feel very proud of herself. As a result, her mental health post birth has been very positive as she enjoys getting to know her baby. Caitin shares some great wisdom in this episode.   Links: Transform Parenting website Transform Your Birth Today Better Birth: Mini Gift Free resource: Medical Necessity vs Choice

No matter the approach one might take for debridement, wound care continues to be an attractive source for audits – they inevitably arise and fester. Case in point: Wachler and Associates, a prestigious law firm in Michigan, currently is representing clients in some 18 wound care audit cases.That is why RACmonitor, producers of Monitor Mondays, has invited Andrew “Drew” Wachler, founder of Wachler & Associates, to be the special guest during the next live edition of the venerable weekly Internet broadcast.The long-running broadcast will also include these instantly recognizable features:• Breaking News: Famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will report about a False Claims Act (FCA) settlement involving a Medicare Advantage provider.• 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: Cate Brantley, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

National Doctors' Day is actually Sunday, March 30, but the one-day nationwide observance is getting an early celebratory start during the next live edition of the venerable Monitor Mondays broadcast.Joining our esteemed panelists will be three well-known physicians: Drs. Stephanie Van Zandt, Clarissa Barnes, and Juliet Ugarte Hopkins. And each doc will have an “open mic” during the 30-minute live Internet broadcast.The long-running weekly 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.

Emma goes briefly into her first two births when she was younger and feeling good through her pregnancies. With baby number 3, she experienced a lot of pain and discomfort and chose to induce her labour. It was a short labour, and resulted in a water birth. Her placenta needed help to be removed. Emma is very pragmatic about women's ability to birth, and she reminds us all how powerful women are, and we can give birth, even when we think we can't. Enjoy Emma's stories.   Links: Transform Parenting website Transform Your Birth Today Better Birth: Mini Gift Free resource: Medical Necessity vs Choice

A clinical documentation integrity (CDI) professional who “knowingly … acts in reckless disregard of the truth or falsity of the information” may ultimately run into issues related to the federal False Claims Act (FCA).The Medicare Fee-for-Service (FFS) Compliance Program on the Centers for Medicare & Medicaid Service (CMS).gov website lists several CMS compliance programs designed to educate and support Medicare providers in “understanding and applying” FFS policies. If the hospital compliance department is not monitoring these resources, it would be prudent for CDI leadership to do so, according to CDI expert Cheryl Ericson, who will be the special guest during the next live edition of the long-running Monitor Mondays Internet broadcast.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: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.

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.

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.

Dr Sarah Buckley is trained as a GP/family physician and has further qualifications in GP-obstetrics and family planning. She is the mother of four adult children, all born at home, and lives in Brisbane, Australia. She is the author of “Gentle birth, Gentle mothering, and Hormonal Physiology of Childbearing  Dr Buckley has been writing and lecturing on pregnancy, birth and parenting since 1997 and is currently a PhD candidate at the University of Queensland, where her research is focused on oxytocin in labour and birth and the impacts of interventions. Dr Buckley's work critiques current practices in pregnancy, birth, and parenting from the widest possible perspectives, including scientific, anthropological, cross-cultural, psychological, and personal.  Today Sarah talks to us extensively about the hormone of oxytocin during labour, breastfeeding and parenting. Our talk reminded me of the intricacies of mother nature's blueprint, and just how well she has set us up for birth and parenting. It left me wondering - when we interfere with birth - at what cost? She encourages us to be fully informed in our decision-making; to listen to our hearts and our intuition; and to claim our rightful role as the real experts in our bodies and our children. This episode is dense in detail, and yet left me feeling in awe of the human journey of reproduction. Learn more about Sarah   Links: Transform Parenting website Transform Your Birth Today Better Birth: Mini Gift Free resource: Medical Necessity vs Choice  

During the next edition of Monitor Mondays, special guest Bill Dombi, senior counsel with Arnall, Golden, and Gregory, will offer an update on the hot-button issues affecting home healthcare, hospice, and long-term home care. These issues include the latest developments related to the Medicare Hospice Special Focus Program, the impact of the Medicare home health payment model, Medicare Advantage (MA) claim denials in post-acute care, and increasing threats to Medicaid support.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: Matthew Albright, chief legislative affairs analyst for Zelis, will report on the latest news concerning healthcare legislation.

Evoking the age-old adage of having “skin in the game,” a Phoenix, Arizona couple last month entered a plea of guilty to one of the largest healthcare frauds in U.S. history.The couple pleaded guilty to criminal charges involving the submission of $1.2 billion in fraudulent claims to Medicare, Medicaid, and other insurers for wound care procedures. The husband-and-wife team have agreed to pay more than $600 million in restitution and face over 20 years in prison, according to famed whistleblower attorney Mary Inman, who will return to Monitor Mondays for its next edition.The venerable 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.

Challenges in reimbursement, benchmarking, and quality reporting are being experienced in many American hospitals. Why is this problem arising?Our special guest during the next live edition of Monitor Mondays will have answers. Penny Jefferson, a seasoned healthcare professional who serves as the Director of Clinical Documentation Integrity (CDI) Services at the University of California at Davis Medical Center, will report on why misinterpretation of the admission types appears to be the culprit, impacting compliance, payment, and patient safety indicators (PSIs).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: 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.

Earlier this week, in the wake of the inauguration of President Donald Trump, a major announcement was made that some hope will lead to new advances in healthcare: “Stargate,” a private venture to build in the U.S. hyperscale data centers for artificial intelligence (AI). The strategic goal is to make the United States the world's leader in AI.Larry Ellison, founder of the relational database company Oracle, indicated that much work in this project will be focused on healthcare, including the promise of better medical diagnostics and imaging, personalized medicine, remote monitoring, and telehealth for patients, according to Edward M. Roche, RACmonitor investigative reporter, whose day job is director of scientific intelligence for Barraclough New York LLC.Roche will be reporting this lead story for the next edition of the long-running Monitor Mondays weekly broadcast.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.• 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 current healthcare legislation.

New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine patients' medical records for diagnoses that risk-adjust, nudging doctors to approve them up to a year after the patient visits, all while pocketing up to 20 percent of the additional revenue generated for Independent Health by these unsupported diagnoses.Reporting the lead story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm Whistleblower Partners.More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here and in RACmonitor.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.• 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 current healthcare legislation.Register now to listen to this exclusive news edition of Monitor Mondays; all this and more will be coming up at 10 a.m. EST on Jan. 13, 2024.

When auditing Annual Wellness Visits (AWV), is the concept still the same as preventive exams concerning modifier 25? The AWV does not include managing medications or managing conditions. However, the rules need to see medical necessity for the E/M on the same date with a -25 modifier. Remember, patients do not have a share of […] The post AWV and Medical Necessity Extras appeared first on Terry Fletcher Consulting, Inc..

Medical necessity—a term that seems straightforward—often becomes a complex hurdle in the world of healthcare, especially in mental health. Joe Feldman, founder of Cover My Mental Health, sheds light on the disconnect between clinical care and legal frameworks, and shares how his nonprofit empowers patients and clinicians to navigate these challenges effectively. What is Medical Necessity? Contrary to what many assume, "medical necessity" is not a clinical term; it's a legal one. As Feldman explains, most healthcare professionals are trained in safe, effective care aligned with ethical standards, not in decoding the legal intricacies of medical necessity. This disconnect often leads to insurance denials, leaving patients stranded without the care they need. Feldman highlights a key concern: insurance companies often deny claims for higher levels of care, such as intensive outpatient programs or residential treatment, by deeming them “not medically necessary.” This decision-making process frequently prioritizes cost-cutting over patient well-being. Resources Mentioned In This Episode Read the full show notes here Use the promo code "GORDON" to get 2 months of Therapy Notes free Start Consulting with Gordon The PsychCraft Network The Practice of Therapy Community Mental Health Wear TN Full Focus Planner Cover MY Mental Health LinkedIn Meet Joe Feldman Cover My Mental Health President and Founder Joe Feldman began advocating for access to mental health care after overcoming denials for his daughter's residential care, including with a successful federal lawsuit. Feldman developed Cover My Mental Health based on his own success overcoming insurance obstacles, with input from leading litigators, appeals experts, clinicians, insurance regulators, and former insurance industry insiders. His advocacy work has included policy-driven discussions with legislators and regulators, a board role with The Kennedy Forum Illinois, presentations to parent groups, and publication of actionable guidance, such as a 2021 article in the Journal of Psychiatric Practice on medical necessity letters. Feldman also serves on the board of Thresholds, a Chicago-based firm providing support to those living with mental illness, and Acadian Kitchens, a for-profit seasonings business in Louisiana.

“He's making a list, checking it twice…”With a nod to the legendary Tin Pan Alley composer Haven Gillespie, who penned the lyrics to the iconic holiday song, senior healthcare consultant Ronald Hirsch, MD has been making his own list of healthcare professionals all year, paying close attention to their deeds in the field of healthcare.Calling them “Hirsch's Heroes,” an annual tradition that began in 2015, Hirsch will reveal those to whom he has bestowed the esteemed honor during the next live edition of Monitor Mondays.Other broadcast segments will include these instantly recognizable features:• The RAC Report: Healthcare attorney Knicole Emanuel 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.• Field Report: Phyisican and attorney Dr. John K. Hall is expected to file a field report on the recent Anthem Blue Cross Blue Shield proposal relative to its anethesia policy which the giant payer has since abandoned.• Legislative Update: Matthew Albright, chief leglistative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Mala M. Rafik of Rosenfeld & Rafik explores MHPAEA's requirements, practical implications for employees, and key compliance tips for employers, excerpted from MCLE's 3/21/2024 live webcast: Understanding How the Mental Health Parity & Addiction Equity Act Impacts Employer Benefits. The full program is available as an on-demand webcast or an MP3 here.  Get 24/7 instant access to hundreds of related eLectures like this one—and more—with a subscription to the MCLE OnlinePass. Learn more at www.mcle.org/onlinepass and start your free trial today! Connect with us on socials!Instagram: mcle.newenglandBluesky: mclenewengland.bsky.socialLinkedIn: Massachusetts Continuing Legal Education, Inc. (MCLE│New England)Facebook: MCLE New EnglandX (Formerly Twitter): MCLENewEngland

Have you ever had your insurance company deny payment for your claim?Have you ever had your insurance company stall or deny a pre-authorization?How long did it take to get the authorization for the medication you've been using to keep yourself alive for the past few years? Was it maddening?During the next edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine the frustration that modern health insurance has become – especially in the context of the recent fatal shooting of a prominent health insurance chief executive officer (CEO).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: Adam Brenman, senior healthcare 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.

It's raining recovery auditors.More denials. More grief. More lost revenue and more palpable anxiety.The seemingly unending war between payers – private and public – and providers continues unabated. The ubiquitous Two-Midnight Rule and the contentious subject of observation versus inpatient status have become an indelible part of America's healthcare system.And that is why the producers of RACmonitor have dedicated the next live edition of the venerable Monitor Mondays Internet broadcast to be the go-to source for the latest audit and regulatory news: a veritable feast of valuable information for you and your team to use.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Substituting for Dr. Ronald Hirsch will be Dr. Tripti Katari, who will be making her Monday Rounds. Dr. Katari is expected to report on updates on the American Medical Association (AMA), which she serves as Legislative Counsel.• 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 healthcare 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.

$23 million: that's the amount that the University of Colorado Health, also known as UCHealth, has agreed to pay to resolve False Claims Act allegations related to its seeking and receiving payment from federal healthcare programs for visits to its emergency departments.The university, headquartered in Aurora, was accused of falsely coding certain Evaluation & Management (E&M) claims submitted to the Medicare and TRICARE programs.Reporting the lede story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm of Whistleblower Partners.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. Ronald Hirsch, 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 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 we continue to monitor and review the latest healthcare news, we are always pleased when word of a new study comes to our attention – especially when the study is within the purview of MDaudit.During the next live edition of Monitor Mondays, the CEO for MDaudit, Ritesh Ramesh, will report the latest results of a new national study – and how the salient takeaway points could help you and your team as you grapple with the dynamic environment of America's healthcare system.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. Ronald Hirsch, 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: Cate Brantley, a senior government affairs liaison 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.

Long a contentious edict from the Centers for Medicare & Medicaid Services (CMS), the Medicare Two-Midnight Rule can be simplified into three basic elements.For the first time, Monitor Mondays, along with esteemed physician advisor Benjamin Kartchner, will be outlining them, along with all that's needed to undo the gordian knot of denials.During the next live edition of the venerable Internet radio broadcast, Dr. Kartchner will complete his discussion as to how detailed clinical updates, assessments, and rationale for continued hospitalization can preemptively address payer scrutiny and reduce denials while optimizing reimbursement for patient care.Other segments during the weekly broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• 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.

Denials in healthcare are a problem.Recently, though, the problem seems to be getting worse, especially with the misapplication of the Two-Midnight Rule by Medicare Advantage (MA) plans, according to Nick Hut, senior editor for Healthcare Financial Management Association (HFMA).Hut reports that MA plans are classifying hospital stays as outpatient observation visits at a significantly higher rate than traditional Medicare even though the rule is supposed to be applied the same way in both programs.And Hut believes the situation is likely to be getting worse because UnitedHealthcare is targeting provider coding while it seeks to bring down medical spending that has been higher than anticipated in recent fiscal quarters.Hut will be reporting this story during the next live edition of Monitor Mondays. He has more than 12 years reporting healthcare policy news and trends.Other segments during the weekly broadcast 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.• Legislative Update: Adam Brenman, senior 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.

A pediatrician under investigation related to accusations that she had engaged in sexual relations with a male patient, having lied about it when applying for another healthcare position, was recently sentenced for making false statements.In another case, a federal contractor agreed to resolve False Claims Act allegations in connection with a government contract related to its storage of unsecured personally identifiable information of Medicare beneficiaries.Recognizing that it's not only a bad idea, but also a crime to lie to a government agency, Monitor Monday's own attorney and physician Dr. John K. Hall will report on how your organization's cybersecurity could put you at risk of false claims liability during the next live edition of the long-running Internet radio broadcast. Specifically, Dr. Hall will review these two recently resolved cases and offer tips to avoid liability.Other segments during the weekly broadcast 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.• 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.

Could you and your care team be at risk when you upgrade a patient from observation to inpatient simply because the patient passed a second midnight in the hospital, based on the Centers for Medicare & Medicaid Services (CMS) contentious Two-Midnight Rule?And what about the expectation? How does expectation enter this equation? And finally, what should be present to change that expectation?During the next live edition of Monitor Mondays, Ben Kartchner, MD, a prominent physician advisor, will thread the needle of this controversial regulation to give his perspective on how the two-midnight expectation can serve as your compass, helping you steer through regulatory challenges, ensure compliance, and prevent unnecessary denials.Other segments during the weekly Internet broadcast 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.• Legislative Update: Cate Brantley, a senior government affairs liaison 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.

The U.S. Department of Justice (DOJ) has reported that one of America's largest urine drug-testing companies has agreed to pay $27 million to resolve allegations of unnecessary drug testing and illegal remuneration to physicians.The False Claims Act allegations resolved by this settlement were originally brought in three lawsuits filed by whistleblowers under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government – and to share in any recovery. Reporting on this major story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm of Whistleblower Partners, LLC. Other segments during the weekly Internet broadcast will include these instantly recognizable features:•Monday Rounds: Juliet Ugarte Hopkins, MD, will be making her 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: Adam Brenman, a senior government affairs liaison 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.

Summary In this episode, Sean and Terry discuss the intersection of sports and healthcare, particularly focusing on the implications of sports injuries on mental health. They delve into the nuances of preventative medicine visits, the complexities of evaluation and management services, and the importance of medical necessity in billing practices. The conversation highlights the challenges healthcare providers face in navigating these areas while ensuring compliance and quality patient care. Takeaways The connection between sports injuries and mental health is significant. Preventative medicine visits can include additional work if abnormalities are found. Medical necessity is crucial in determining billing practices. Providers must ensure that services billed are significantly separate from preventative services. The guidelines for evaluation and management services have changed, adding complexity. Subjectivity in medical appropriateness can lead to confusion in billing. Patients often bring up additional concerns during preventative visits. Providers should be cautious about billing for services that may not be necessary. Documentation is key to supporting claims for additional services. Understanding payer expectations is essential for compliance.

A major drug company's attempt to turn 340B drug pricing program discounts into rebates made big headlines in recent weeks. Maureen Testoni, president and CEO of 340B Health, will review how this potentially major upheaval came about, how 340B stakeholders responded, and how the drugmaker backed off after the federal government threatened it with massive penalties.This debate is by no means over.The idea of imposing rebates in 340B is not a new one, and the concept has come back into prominence recently amid the ongoing implementation of the Inflation Reduction Act, which will have important effects on 340B.Other segments during the weekly Internet broadcast 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.• Legislative Update: Folana Houston, assistant general counsel 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 violent crime has trended slightly downward throughout the United States over the last year, a wound to this country's collective psyche that appears reluctant to close is workplace violence in America's hospitals.Reporting the lead story during the next live edition of Monitor Mondays will be special assignment contributor Dennis Jones, senior director of revenue cycle at Jefferson Health.Jones returns to his beat to continue his reporting of this issue. Among those healthcare professionals most at risk for workplace violence are nurses and those who work in emergency rooms. In fact, a 2021 study conducted by the Cleveland Clinic revealed that workplace violence tends to be four times more prevalent in healthcare than in other industries. Jones is expected to have more details on “Violence in America's Hospitals.”Other segments during the weekly Internet broadcast 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.• Legislative Update: Cate Brantley, senior government 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.

Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street Health's primary care clinics, according to a news release issued by the U.S. Department of Justice (DOJ). Reporting the lead story during the next live edition of Monitor Mondays will be Max Wollman, a partner in the Washington office of Whistleblower Partners, LLP.The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Joseph Stinson. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mr. Stinson is expected to receive $9.9 million, according to the DOJ.Other segments during the weekly Internet broadcast 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. •Legislative Update: Adam Brenman, senior government  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.

You need to get paid properly for surgical procedures on the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only (IPO) List, according to Mary Beth Pace, vice president of care management at Trinity Health, and also the special guest during the next live edition of Monitor Mondays.Pace, in making the statement, was referring to rules and regulations set forth in the Federal Register for Medicare in 2024. She also alleges that some Medicare Advantage (MA) plans are not abiding by some of those rules and regulations. Pace says all MA plans need to abide by the IPO and reimburse correctly.But does your facility have the processes in place to ensure that you are being paid correctly for surgical procedures on the IPO? Be sure to listen in order to find out.Other segments during the weekly Internet broadcast 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.• 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.

What's wrong with this picture?With more than 10 years of the Centers for Medicare & Medicaid Services (CMS) Two-midnight Rule now behind us, one would presume that most healthcare professionals should know what determines an inpatient status. But some don't.That is why RACmonitor has invited renowned physician and attorney Dr. John K. Hall to report on the requirements and risks associated with inpatient order documentation during the next edition of Monitor Mondays.Other segments during the weekly Internet broadcast 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.Legislative Update: Cate Brantley, a senior government affairs liaison 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.

A comprehensive new survey featuring responses from more than 1,500 U.S. patients reveals that they are not only frustrated by poor provider support, but also are experiencing tangible health setbacks – especially when waiting to refill prescriptions and being placed on hold while waiting to speak to a caregiver.Israel Krush, CEO and Co-Founder of Hyro, the healthcare vendor whose company sponsored the survey, is scheduled to be the special guest during the next live edition of the long-running Internet broadcast Monitor Mondays, produced by RACmonitor.Hyro's “Voice of the Patient” survey and accompanying report highlight significant gaps between patient needs and the current support available through healthcare delivery channels.Other segments during the weekly Internet broadcast 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.• Legislative Update: Adam Brenman, a senior government affairs liaison 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.

Are you ready to take control of your health and kick diabetes to the curb? Join Dr. Morgan Nolte as she unveils the powerful Zivli Diabetes Prevention and Reversal Program. This revolutionary program isn't just about managing your health—it's about transforming it.With a focus on preventing and reversing insulin resistance, the Zivli program offers an in-depth online course that covers everything from nutrition and intermittent fasting to stress management and physical activity.In this episode, you'll learn:The 5 choices we ask every Zivli member to make to ensure your success.How the Zivli program tackles insulin resistance, the root cause of diabetes.What's included in the comprehensive online course, plus the benefits of lifetime access.The power of live Q&A sessions, group coaching calls, and accountability pods for your success.How to register for our FREE (fully updated) Blood Sugar Boot Camp.Tune in to find out how this transformative program values growth, authenticity, persistence, integrity, and commitment—and how you can be part of it. Your path to a healthier you starts here!Subscribe & ReviewSubscribing and leaving a rating and review are important factors in helping the Reshape Your Health Podcast and the YouTube Channel reach more people. If you haven't already subscribed, please do that today.We would also be grateful if you left a rating and review, too. In your listening app, scroll to the “Ratings and Reviews” section, then click “Write a Review” and let us know what you enjoy about our show. We appreciate you taking the time to show your support. Thank you! Resources From This Episode>> Join Zivli>> Test Your Insulin at Home>> Free Low Insulin Food Guide>> Register for the FREE Blood Sugar Boot Camp>> Book a Zivli Discovery Call>> Draft Letter of Medical Necessity

In response to the devastation caused by Hurricane Debby, now Tropical Storm Debby, the Centers for Medicare & Medicaid Services (CMS) has announced additional resources and flexibilities to support the affected states of Florida, Georgia, and South Carolina.Following President Biden's emergency declarations and U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra's Public Health Emergency determination, CMS is working closely with these states to ensure continued access to critical healthcare services.Importantly, CMS is offering state waivers and other support to help healthcare providers in the impacted regions maintain operations and deliver essential care during this challenging time, according to Timothy Powell, an independent senior healthcare consultant, who also serves as the national correspondent for ICD10monitor and will be the special guest for the next edition of Monitor Mondays.Other segments during the weekly Internet broadcast 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.• 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.

The U.S. Department of Justice (DOJ) has a new whistleblower reward initiative called the DOJ Corporate Whistleblower Awards Pilot Program.The Program, which seeks to fill gaps left by existing whistleblower reward programs, incentivizes whistleblowers to bring tips to the DOJ about types of healthcare fraud not already covered by the False Claims Act (FCA). According to Monitor Mondays special guest Mary Inman, the new Program raises the stakes for the entire healthcare industry, especially among those who typically ignore or disregard internal reports concerning whistleblowers.Other segments during the next edition of the weekly Internet broadcast 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.• Legislative Update: Cate Brantley, a senior government affairs liaison 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.

This episode Terry and Sean take on adding services to your revenue mix and the costs for doing so if "Medical Necessity" is not met. There is a ton to unpack in the episode. Sean also blogged about this topic on LinkedIn Monday, July 1, 2024... take a look at that blog!

Most of the all star team was back for this one and it was an outstanding discussion of the G2211, Medical Necessity vs. Correct Coding, SNF Visits and Medical Necessity, and so much more!