Podcasts about payer denials

The initiative to vaccinate enough Americans to achieve herd immunity against the deadly coronavirus appears to be stalling – this in the face of increases in infection rates.According to data from the Centers for Disease Control and Prevention (CDC), the country has experienced an average of 65,000 new cases in the last seven days. Reporting our lead story during the next edition of Monitor Mondays will be John Foggle, MD, who returns to the broadcast following his stint as a frontline physician caring for COVID-19 patients at Rhode Island’s alternative site field hospital as a member of Brown University’s emergency medicine department. Dr. Foggle has a distinguished career in medicine, particularly as it relates to his being a consultant with the World Health Organization (WHO) in Fiji and Tonga at the global outbreak of the virus in late February and early March 2020, designing guidances and conducting healthcare worker training in preparation for COVID-19.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 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.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: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Resource: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/cardiology/QRG-Cardiology-Notification-Program-for-Commercial-Plans.pdf

“Ridiculous denials are frustrating. Vent, and then respond,” Dr. Andrew Markiewitz advises. “But ask: are you arguing over the Titanic’s deck chairs?”  “Insurers may correctly identify unsubstantiated diagnoses,” Markiewitz added – and, if their findings are legitimate, return the money. If the DRG or reimbursement doesn’t materially change, after all, where’s the value?Fighting the fight worth fighting will be the topic of the next edition of Monitor Mondays, when Markiewitz, a physician advisor at the Cincinnati-based TriHealth, Inc., will share his experiences in appealing DRG denials.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 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.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: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

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.

Now that the auditing reset button has been pressed, you and other providers can expect a torrent of audits and recoupments. In this new aggressive auditing environment, propelled by commercial as well as governmental auditors, providers must continually update their approach in response.Against this chaotic background, there’s a new legal approach to audit defense advocated by Wachler & Associates. During the next live edition of Monitor Mondays, prominent healthcare attorney Andrew Wachler, managing partner at Wachler and Associates, will report on the latest legal theories, based on recent case law, to respond to technical and other audit denials.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.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 report the Monitor Mondays lead story.

“Are your CFOs agitated by the increase of outpatients in inpatient beds because of the removal of total knee arthroplasty (TKA), total hip arthroplasty (THA), and hundreds of other procedures from Medicare’s Inpatient-Only List (IPO) list?” asked Julie Collins recently on the RAC Relief listserv. “If the surgeon’s office is securing the prior authorization, how are they doing with securing the proper classification (inpatient/outpatient)? Are they using a dartboard to determine which classification they request?”During the next live edition of Monitor Mondays, Collins, manager of utilization management at TriHealth in Cincinnati, Ohio, will report on how her healthcare system is addressing this crucial issue.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.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 report the Monitor Mondays lead story.

After all this time, you could still be doing it wrong when it comes to Condition Code 44.If your hospital has been following the Medicare Condition Code 44 process associated with 42 CFR 482.30 because policy issued by the Medicare Advantage or commercial plans with which you’re contracted dictates its use, this may be the case, according to Dr. Juliet Ugarte Hopkins, the special guest during the next live edition of Monitor Mondays.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.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.

With the purchase by UnitedHealthcare (UNC) of Change Healthcare, providers are contemplating notable differences between two sets of quidelines. Change Healthcare owns InterQual criteria, while UHC has traditionally used MCG criteria.Becoming familiar with the variances in terms of observation timeframes, screening methodologies, severity of illness thresholds, and intensity of service thresholds for levels of care will be the topic reported on by Kelvin Valera, MD, a healthcare consultant and physician advisor, during the next edition of Monitor Mondays.Other segments to be featured during the live broadcast include the following:Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report. Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report that the pharmaceutical company Roche and Medicare Advantage insurer Humana have agreed to pay $12.5 million to the U.S. government to resolve allegations that the companies violated the anti-kickback statute – marking the first False Claims Act (FCA) settlement resulting from a pharmaceutical company’s alleged payment of kickbacks to a Medicare Advantage Organization.

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.

The Centers for Disease Control and Prevention (CDC) is forecasting that there will be more than 500,000 deaths from the coronavirus in the U.S. by the third week of February. In the meantime, there has been a flurry of activity by major pharmaceutical companies to work together to help meet the huge demand for vaccines, all against the backdrop of an emerging trend: vaccine hesitancy. Driven by misinformation, lack of trust, and concerns about safety and efficacy, vaccine hesitancy is considered to be one of the top global health threats, according to the World Health Organization (WHO).In the first portion of an exclusive series produced by ICD10monitor for Talk Ten Tuesdays, Erica Remer, MD will kick things off with a report on the subject, including a listener survey conducted during the live broadcast. Remer is a volunteer inoculator with the Medical Reserve Corps of the Cuyahoga County Board of Health.The live broadcast will also feature these other segments:COVID-19 Report: John Foggle, MD, a frontline physician caring for COVID-19 patients at Rhode Island’s alternative site field hospital as a member of Brown University’s emergency medicine department, will report on the latest news coming from the frontlines of America’s battle against the deadly coronavirus.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on how healthcare and politics are inextricably entwined.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 our lead story—the first installment in a three-part series on Vaccination Nation.

Billions of dollars in overpayments are levied annually against healthcare providers by the Centers for Medicare & Medicaid Services (CMS), based on the use of extrapolation audits. And while thousands of extrapolation audits are completed each year, the targeted provider or organization most likely will appeal the use of extrapolation.In nearly all cases, the appeal is focused on one or more flaws in the methodology used to create the sample and calculate the extrapolated overpayment estimate. But how do you uncover the flaws?Reporting our lead story during the next edition of Monitor Mondays, with answers to that question and others, will be Frank Cohen, senior healthcare analyst and director of business intelligence at DoctorsManagment.Other segments to be featured during the next live broadcast include the following:Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.

Even as the nation continues to struggle with the coronavirus pandemic, President Joe Biden, who took office Thursday as the 46th President, signed executive orders mandating that masks be worn on federal property and for interstate travel on trains, transit systems, and airlines – this being part of the President’s agenda for the first 100 days in office. Meanwhile, shortages of the COVID-19 vaccine are being reported throughout the country, most notably in the Big Apple, where New York City Mayor Bill de Blasio reportedly said the city would exhaust its vaccine supply this week.Reporting our lead story during the next edition of Monitor Mondays will be John Foggle, MD, a frontline physician caring for COVID-19 patients at Rhode Island’s alternative site field hospital as a member of Brown University’s emergency medicine department.Other segments to be featured during the live broadcast include the following:Cyber Watch: Special Series: RACmonitor investigative reporter Edward Roche will begin a new series on Monitor Mondays, focusing on cyber security issues imperiling the U.S. In his first report, Roche will describe how New York City is a city in crisis when it comes to how it is confronting serious issues related to its massive vaccination program – it’s not working.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.

Most physicians are expected to see in an increase in payments from Medicare, thanks to the latest COVID-19 relief bill. But with good news always comes some caution.First of all, the more that is paid, the more can be recouped during an audit. And with respect to provider compensation models that rely on relative value units (RVUs), it is possible that the increase in work RVUs may exceed the increase in the total RVUs – meaning that a provider may make more than what is proportional to overall practice revenue. This could have implications with respect to fair-market value, and should be watched very closely.Reporting our lead story on this timely matter during the next live edition of Monitor Mondays will be Frank Cohen, senior healthcare analyst and director of business intelligence at DoctorsManagment.Other segments to be featured during the live broadcast include the following:Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.

With the calamitous year of 2020 now in the rearview mirror, slowly receding from view, its legacy is expected to have a haunting effect, now and in the future of America’s system of healthcare. And decisions being made in Washington, D.C. will impact every practice, facility, and health system.With so many major changes expected to take place in 2021, you need to stay informed and alert – and RACmonitor and Monitor Mondays will help you stay out in front of the issues that will alter the delivery of healthcare, both now and throughout a new year that has arrived amid a time of unprecendented uncertainty.During the next edition of Monitor Mondays, host and RACmonitor Publisher Chuck Buck will have an all-star lineup of experts on hand to tell you what to watch out for, marking the 2021 premiere for the weekly Internet broadcast, which is celebrating 11 years of live programs.Segments to be featured during the live broadcast include the following:340B Health: The president and CEO for 340B Health, Maureen Testoni, is expect to report on a recent advisory opinion from the U.S. Department of Health and Human Services (HHS) General Counsel, saying that drug companies denying 340B discounts to hospitals using community-based pharmacies are wrong and should stop.COVID-19: Frontline physician John Foggle will provide a real-time update on the raging spread of the coronavirus, at a time when public health experts are predicting that the U.S. death toll could eclipse 450,000 by February.Home Health and Hospice: William Dombi, president of the National Association of Home Care and Hospice, will report on the impact of COVID-19 and the public health emergency (PHE) on his association’s members.IRF: One of the nation’s foremost authorities on inpatient rehabilitation facility (IRF) services, Angela Phillips will return to report on the resumption of reviews by Recovery Audit Contractors (RACs) on IRFs.The Special Report: Should medical record auditors be certified? RACmonitor investigative reporter Ed Roche will report on why he believes there is a need.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 of the recently passed surprise billing law.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.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.

Out in the West Texas “town” of El Paso, a number of COVID-19 patients are being treated with a new monoclonal antibody infusion called bamlanivimab. Now in the second week of the operation being conducted in the El Paso Convention Center’s makeshift hospital, Dr. Edward Michelson, Chair of the Department of Emergency Medicine at Texas Tech University Health Sciences Center, reports that while treatments are underway, there hasn’t been enough time to gather data on the effects and outcomes. Dr. Michelson, who appeared on Talk Ten Tuesdays in October 2017, will return to the live broadcast this coming Tuesday with a live update on the new therapy. Also on tap for the broadcast:Tuesday Focus: New COVID-19 Codes: The Centers for Disease Control and Prevention (CDC) recently announced further additions to ICD-10-CM related to COVID-19. Additionally, the Centers for Medicare & Medicaid Services (CMS) has posted new guidelines for ICD-10 CM/PCS coding and an updated MS-DRGs, Version 38.1. Updates include new ICD-10-CM and PCS codes for COVID-19. Reporting our Tuesday Focus will be Susan Gatehouse, founder and CEO for Axea Solutions. RegWatch: Stanley Nachimson, former CMS career professional-turned-well-known healthcare IT authority, will report on how healthcare and politics are inextricably entwined. 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 ICD-10 coding relative to infusion services. 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.

Amid the chaos created by the coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) released two major final rules this week: the 2021 Physician Fee Schedule and the Outpatient Prospective Payment System (OPPS), with the latter having been widely anticipated. Both final rules portend significant new regulatory changes for providers, patients, and payors. Given the gravity of these new changes, the next upcoming Monitor Mondays broadcast will encompass a special live open door forum to answer questions from listeners.Segments to be featured during the live broadcast include the following:Court Report: Famed whistleblower attorney Mary Inman, partner in the London law office of Constantine Cannon, will return to the broadcast to report on three major whistleblower cases.COVID-19: Frontline physician John Foggle will provide a real-time update on the raging spread of the coronavirus — at a time when Centers for Disease Control and Prevention (CDC) Director Robert Redfield is predicting that the U.S. death toll from COVID-19 could eclipse 450,000 by February.Monday Focus: Utilization Review: Dr. John Zelem, founder of Streamline Solutions Consulting, Inc., will report on the role of utilization review amid the pandemic.Rural Health Report: The nation’s rural communities are reported to be ravaged by COVID-19. Leslie Marsh, the CEO for Lexingtion Regional Health Center, will report on how her facility is being impacted by the pandemic.The 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: 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: 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.

A whistleblower recently exposed an alleged risk-adjustment scheme that was apparently designed to artificially inflate reimbursement provided under Medicare Part C, aka Medicare Advantage (MA).The accompanying lawsuit alleged that GHC hired an outside vendor to review and “improve” its risk adjustment scores. According to the whistleblower, GHC submitted tReporting our lead story on this matter during the next live edition of Monitor Mondays will be Max Voldman, JD, an associate of Constantine Cannon.Other segments to be featured during the live broadcast include the following:Special Report: Bereavement: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will don her case management hat to report on how hospital personnel are dealing with the death of patients in the wake of COVID-19, which has claimed the lives of more than 259,000 here in the U.S. 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.

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.

There has recently been, as some might suggest, the luxury of taking a brief hiatus from medical record audits.But that was then, and this is now.Because now is the time to prepare, assess timeframes and provider requirements, and ensure that a proper compliance plan is in place. Certainly, audits are a growing source of concern, but there is no need for panic when adequately prepared, as you’ll learn from Susan Gatehouse, founder and CEO for Axea Solutions, who will be the special guest during the next live edition of Monitor Mondays.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, 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.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 coronavirus winter surge is quickly approaching, and at a time when the United States is experiencing record numbers of daily positive COVID-19 tests, with corresponding increases in hospitalizations expected to follow. What the country needs now is for payers – both governmental and commercial – to reinstitute post-acute authorization waivers, since such waivers have largely expired. Currently, UnitedHealthcare, Aetna, and Anthem have no post-acute authorization waivers in place for any patients, including COVID-19 patients.Without these waivers, hospitals must again go through the authorization process for post-acute stays. Reporting our lead story during the next edition of Monitor Mondays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health in North Carolina. 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, joins the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.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.

The United States Department of the Treasury’s Office of Foreign Assets Control (OFAC) recently issued an advisory on potential sanction risks for facilitating ransomware payments. It warned that entities, including hospitals, paying off ransomware demands might be subject to civil monetary penalties under the International Emergency Economic Powers Act (IEEPA).This action places hospitals in danger of being guilty of such violations, even when they are the victim of a crime. Reporting our lead story during this edition of Monitor Mondays is RACmonitor investigative reporter Ed Roche, who has been reporting on ransomware for RACmonitor since 2017.Other segments featured during the podcast include:Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.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.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.

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

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

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.

The Centers for Medicare & Medicaid Services (CMS) has ordered Medicare Advantage Organization (MAO), -hired subcontractors, to stop issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized. Reporting our lead story during this edition of Talk Ten Tuesdays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health in North Carolina. Dr. Hu was one of several healthcare executives who convinced CMS to issue a recent memo outlining this change. Dr. Hu will explain the coding significance of this new directive, particularly as it relates to coding and clinical validation denials, which by definition occur retrospectively, and often after a claim was initially paid. The live broadcast will also feature these other segments:The Dunn Report: National health information management (HIM) expert and past president of the American Health Information Management Association (AHIMA), Rose Dunn, returns to the broadcast to report the best approach to dealing with line-item claim denials.Mental Health Report: H. Steven Moffic, MD, one of America’s foremost psychiatrists, returns to the broadcast to report on how cataclysmic events, here at home and abroad, are impacting our mental health.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.The Coding Report: Laurie Johnson, senior healthcare consultant for Revenue Cycle Solutions, LLC, returns to the broadcast to report on the need for facilities to develop their own coding guidelines.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, reports on another thought-provoking topic that has captured her attention.

The Centers for Medicare & Medicaid Services (CMS) has moved to stop Medicare Advantage Organization (MAO)-hired subcontractors from issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized.The practice is reported to be extremely widespread and used against non-contracted providers: small, often rural hospitals that tend to be more vulnerable to these tactics.Reporting our lead story during the next live edition of Monitor Mondays will be Lisa Banker, MD, formerly chief medical advisor for revenue integrity at CarolinaEast Health System. Dr. Banker led the effort to convince CMS of the need to issue a recent memo on this topic.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 the latest news that’s happening at the intersection of COVID-19 and the SDoH. Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) will reimburse a greater number of relative value units (RVUs) associated with office-based evaluation and management (E&M) visits, the agency announced recently.In order to achieve budget neutrality, CMS will reduce the payment per RVU. With this change, CMS is allocating a larger proportion of its total spending to office-based physicians, at the expense of surgeons and hospital-based physicians.Here’s the rub: organizations that utilize RVUs in their physician compensation arrangements and continue to pay the same 2020 rates per RVU on the increased number of 2021 RVUs will experience a dramatic decline in operating income. Reporting our lead story during this edition of Monitor Mondays is Adam J. Klein, who heads ECG’s Financial Services practice.Other segments to be featured during the live broadcast include the following:Whistleblower Update: Famed whistleblower Mary Inman, partner in the law office of Constantine Cannon, returns to the broadcast to report on two whistleblower cases that have dropped from the radar screen, but nevertheless are essential for re-examination.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.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.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.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Unlike the Cold War arms race between the then-Soviet Union and the United States, today’s arms race is being fought before computer monitors, and in the deep corners of computer laboratories. And the weapon of choice: algorithms.This fierce fighting is taking place between auditors and providers, and the stakes are high: money. Lots of it.No stranger to chronicling the former Cold War arms race, Edward Roche, RACmonitor’s investigative reporter, returns to the Monitor Mondays broadcast to report on how algorithms created by payers tend to foster a camouflage of mediocrity for providers.Other segments to be featured during the podcast:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makesg his Monday Rounds with another installment of his popular segment.

In recent weeks, several major pharmaceutical manufacturers have taken actions that could lead to narrowing the 340B Drug Pricing Program, which provides outpatient drugs to safety-net hospitals, health centers, and clinics at discount prices. The savings are invested in care for patients with low incomes, living in rural communities.The actions by Eli Lilly, Merck, and Sanofi are being challenged by a coalition of safety-net providers, including 340B Health, which represents more than 1,400 340B hospitals. Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health, who will discuss why she is concerned by these actions by drugmakers.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 SDoH. Ellen also conduct the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

California is one of two states in the country that rewards whistleblowers for bringing forward information about private insurance fraud. A recent $24 million settlement with pharmaceutical giant Abbvie over the marketing of the company’s blockbuster drug, Humira, demonstrates the law’s effectiveness.The settlement agreement was reached last week following allegations that the company violated California’s Insurance Frauds Prevention Act. Abbvie agreed to the settlement despite continuing to deny any wrongdoing.On the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will provide details on this important news story.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 SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

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

Center of Medicaid and Medicare Services (CMS) has been posting proposed rules for Medicare this past week. Already, CMS has issued the final rules for Inpatient Psychiatric Facilities, Skilled Nursing Facilities, and Hospices; and we are still awaiting the final rule on the Inpatient Hospital payment rules. In light of these proposed rules we’ve asked two experts, Dr. Ronald Hirsch and Terry Fletcher to explain the significance of these proposals in a special Friday edition of Monitor Mondays.This special edition of Monitor Mondays was sponsored by Dr. Ronald Hirsch. You can visit his website here: https://www.ronaldhirsch.com/ or you can purchase his 'Hospital Guide to Contemporary Utilization Review, Second Edition' at https://hcmarketplace.com/contemporary-utilization-review

Could Alexander VS. Azar really be over? This week's Monitor Mondays episode we've called upon or resident healthcare attorneys Knicole Emanuel Esq., David Glaser Esq. and our guest host John K. Hall MD, JD to dissect and assess the complicated case.The case has been disorganized since the beginning, possibly leaving more questions than answers. This Monitor Mondays round table will analyze procedural aspects of the case and what it could potentially mean for providers, analyze where the decision has risk for providers, and provide guidance of how providers should respond in the future.Other segments to be featured during the live weekly Internet radio broadcast include the following:SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest research from the Urban Institute and Robert Wood Johnson Foundation about Unemployment, and Loss of Employer-sponsored insurance. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will have the latest legislative news coming from Washington.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Court Report: Mary Inman, Esq. has the latest report on Pfizer's charitable contributions and what future court rulings affect on the industry, and drug prices.

Last week, pharmaceutical giant Novartis paid $51 million to settle a Massachusetts suit about patient copay waivers. The DOJ press release notes that this is the 14th settlement of this kind to come from the Boston area. In related news, the Government brought a suit against Regeneron alleging that the company had a scheme of very well calculated charitable giving that steered patients to its macular degeneration drug, which costs $1,850 per dose, and away from a competitor’s drug, which costs $55 per dose.We are joined this week by Mary Inman, Esq. who has the latest on the Novartis suit and the FCA Allegations and how the court rules might have expensive ripple effects on the industry, and on drug prices.Other segments to be featured during the live weekly Internet radio broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the managed care plans that are addressing the SDoH amid COVID-19. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright, now chief legislative affairs officer for Zelis, reports on the extension of PPP and new HHS guidance on CARES Act and cost-sharing for COVID-19 testing.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, joins 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.

The advent of the COVID-19 pandemic in the United States has generated nearly 2.5 million positive diagnoses, nearly 125,000 deaths – and dozens upon dozens of instances of modern-day snake-oil salesmen seeking to profit amid all of the chaos.Presenting the lead story during this edition of Monitor Mondays is Edward M. Roche, who will describe the various ways in which federal authorities are looking to stamp out the opportunistic fraudsters.Other segments to be featured in the podcast:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick,reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright, reports on the status of key healthcare legislation.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment.

Don't let your guard down, post COVID-19 respiratory failure denials are on the horizon. Andrea Taylor from Enjoin reports why we aren't seeing denials yet and tips for appeals and waivers.Other segments featured during the podcast include:RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick reports on the National Health and Nutrition Examination Survey. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright reports on the status of key healthcare legislation and the healthcare provider relief fund.Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD makes his Monday Rounds with another installment of his popular segme

Faced with rising numbers of COVID-19 cases, one hospital struggled to find adequate medical/surgical beds due to the challenges it had with discharging COVID patients. With a strong desire to address the need for surge capacity and to meet patient needs for inpatient rehabilitation, the challenge was met by the team at Henry Ford Macomb Hospital in Michigan, as you’ll learn during this edition of Monitor Mondays.Longtime RACmonitor contributor Angela Phillips will report on how the hospital kept the Inpatient Rehabilitation Facility (IRF) open, providing much-needed rehabilitation services while assisting the organization in meeting the needs of an influx of COVID patients and managing throughput to open acute beds as needed. Phillips, long considered be one of the nation’s foremost IRF authorities, is the president and CEO of Images & Associates.Other segments featured on the podcast:RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.Court Report: Famed whistleblower attorney Mary Inman reports on the recent court case that saw Med Analystic lose its battle to establish a new breed of corporate whistleblower outsiders.SDoH Report: Ellen Fink-Samnick, reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, reporting on risky business during the pandemic.Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment.

New York City-based RACmonitor investigative reporter Ed Roche returned to Monitor Mondays to report on developments in contact tracing: one of the newest tools in the fight to contain the deadly novel coronavirus that causes COVID-19.A hefty amount of money is being invested in contact tracing, including the development of new automated tools. But Roche reports his concern that some of the models being proposed may complicate how we exercise our Constitutional right to privacy.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic. Risky Business: Healthcare attorney David Glaser, reports on when HIPAA does, and does not, limit the ability to publicly comment on a situation like a Covid Outbreak during his Risky Business segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.1qq

Long-term care providers nationwide are seeking to identify ways to mitigate the uncontrolled spread of the COVID-19 virus amid vulnerable populations. Case in point: “drop teams” of physicians, infection preventionists, and nurses that could be deployed to any post-acute care space that was felt to be at risk.After seeing an outbreak at LifeCare Center in Kirkland, Wash., physician leadership and case management at MultiCare in Spokane, Wash. brainstormed ways to prevent a similar local occurrence.During this edition of Monitor Mondays MultiCare’s Ben Kartchner, MD, reports on how the drop teams are working in the region – offering lessons learned from one of the nation’s coronvirus hot spots.Other segments on the podcast include:RAC Report: Healthcare attorney Knicole Emanuel files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment, reporting on risky business during the pandemic.Monday Rounds: Ronald Hirsch, MD makes his Monday Rounds with another installment of his popular segment.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays devoted additional time during the live broadcast to answer your questions.

While much of today’s healthcare news is righty focused on the efforts to stave off the global coronavirus pandemic, there is other news to report – and Monitor Mondays will have a complete wrap-up on all of it during the next edition of the weekly Internet radio broadcast, while also looking ahead.And given the tendency of the Centers for Medicare & Medicaid Services (CMS) to issue waivers and guidance with a unique style of ambiguity, a great deal of confusion also continues to come from hospitals and health systems in their efforts to remain compliant – while at the same time tending to their mission of delivering patient care amid the crisis. So during this special 60-minute live edition, we’ll also have our panelists standing by to answer your questions.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report.Monday Focus: Kathy Pride, executive vice president of coding and documentation services for Panacea Health, will report on two interim final rules, including an expansion and relaxation of guidelines for telehealth services.Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report on two prominent examples of the need for independent regulatory oversight: the removal of the Inspector General of the U.S. Department of Health and Human Services (HHS), and news that Rick Bright, former director of the Biomedical Advanced Research and Development Authority, has filed a whistleblower complaint with the Office of Special Counsel, claiming that he was transferred to a “less impactful position” at the National Institutes of Health (NIH) after he was reluctant to promote the use of drugs such as hydroxychloroquine to treat COVID-19 patients.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.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on regulatory ambiguity during the pandemic.Outpatient Therapy Update: Nancy Beckley, president of Nancy Beckley and Associates, will return to the broadcast to report on inequities for outpatient therapy providers as it pertains to payment, reimbursement, telehealth, and service delivery.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. Special Report: RACmonitor investigative reporter Edward C. Roche, PhD, JD, will provide a status report on COVID-19 testing in the United States.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during this live broadcast to answer your questions. Returning to the broadcast will be Matt Lambert, MD, an emergency medicine physician and chief medical officer for Curation Health.

Pursuant to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the U.S. Department of Health and Human Services (HHS) has allocated $50 billion to providers and other healthcare facilities in the form of a one-time payment, which does not need to be paid back.The payment comes with terms and conditions that recipients must follow, however, including permissible uses for the payment – and failure to follow the terms and conditions, including documentation requirements, may result in an audit or other allegations of fraud and abuse.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick reports on the news that’s happening at the intersection of COVID-19 and SdoH. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, reporting on regulatory ambiguity during the pandemic.Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during this live broadcast to answer your questions.

The global COVID-19 pandemic has presented a multitude of logistical challenges to healthcare providers across the country and beyond. But few are as daunting as the protocols utilization management (UM) directors are being asked to implement regarding patient status assignment.Delivering a riveting report from the front lines of the pandemic during this edition of Monitor Mondays, Stephanie Van Zandt, MD, Medical Director and Physician Advisor with BayCare Health System, a nonprofit healthcare organization that connects Florida residents with services at 15 hospitals across the state.Van Zandt describes the pitfalls and intricacies of the five-pronged policy she helped develop for BayCare as admissions continued to swell amid the pandemic, which has produced nearly 30,000 confirmed COVID-19 cases in the Sunshine State, along with nearly 1,000 deaths.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, reports on the news that’s happening at the intersection of COVID-19 and SdoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, reporting on telehealth and private payers during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment. COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays have devoted additional time during the broadcast to listener questions.

The costs of managing prolonged ICU stays for COVID-19 patients, combined with lost revenue from decreased ambulatory visits and the cancellation of elective procedures, will have health systems and provider groups emerging from the ongoing pandemic with significant financial challenges. It will be more important than ever to ensure that clinical documentation reflects the true complexity of care being delivered. Reporting our lead story during this edition of Talk Ten Tuesdays will be Matt Lambert, MD, an emergency medicine physician and the chief medical officer for Curation Health.The live broadcast will also feature these other segments:Mental Health Report: H. Steven Moffic, MD, one of America’s foremost psychiatrists, returns to the broadcast to report on the impact of climate change on mental health – part of an exclusive series he is authoring for ICD10monitor.Tuesday Focus: The Centers for Medicare & Medicaid Services (CMS) recently announced expanded coverage for essential diagnostic services amid the COVID-19 pandemic. Susan Gatehouse, founder and CEO of Axea Solutions, reports on this latest development.Coding Report: Laurie Johnson has an update on the deadly coronavirus that continues to dominate international as well as domestic news headlines. TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will return to the broadcast to report on another thought-provoking topic that has captured her attention.

“Although Office of Medicare Hearings and Appeals (OMHA) office space is closed to the general public, OMHA remains open for business with employees working under maximum telework flexibilities, per U.S. Office of Personnel Management guidance.” -OMHA website.Indeed, “OMHA hearings and appeals processing measures are proceeding as scheduled,” the notice reads. “Unless an appellant is notified directly that a hearing has been postponed or canceled, appellants should continue to appear for hearings by telephone, as scheduled.”Through teleconferencing and phone calls, many administrative law judges (ALJs) are exercising flexibility in rescheduling such hearings or granting extensions to file for a hearing. Furthermore, the Centers for Medicare & Medicaid Services (CMS) has suspended new Medicare fee-for-service audits through the duration of the public health emergency, as you’ll hear more about during this edition of Monitor Mondays. Reporting our lead story during the weekly broadcast will be Andrew Wachler, Esq., a familiar figure at OMHA and managing partner of Wachler & Associates.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SdoH. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, reporting on telehealth therapy.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during this live broadcast to answer your questions.

Custodial admissions are problematic for hospitals under normal circumstances. But now, incredible demands placed upon facilities by COVID-19 create even more challenges, as you’ll learn during the next edition of Monitor Mondays – when Juliet Ugarte Hopkins, MD, will return to the broadcast as its special guest to report on the issues that are hampering efforts to keep hospital beds open for the patients who require care for their medical conditions.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SdoH. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, will join the broadcast with his trademark segment, in which he reports on the impact of COVID-19 on America’s teaching hospitals.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during the live broadcast to answer your questions. The COVID-19 Q&A is sponsored by Curation Health.

The confluence of the global COVID-19 pandemic and the World Health Organization (WHO) designation of April 7 as World Health Day is fast approaching.Nonetheless, the organization is asking its global partners to take the time to recognize the work of nurses and midwives, acknowledging the “critical role they play in keeping the world healthy,” marking the raison d'être for the International Year of the Nurse and Midwife. Reporting our lead story during this edition of Talk Ten Tuesdays Lorraine Fernandes, president of the International Federation of Health Information Management Association (IFHIMA), who says that “World Health Day gives us a unique opportunity to explore the ways IFHIMA supports their 23 member nations and other members, including individuals, corporate and educational institutions.” Fernandes will also report on initiatives to advance the IFHIMA mission: “a healthy world enabled by quality health information.”The live broadcast will also feature these other segments:RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional turned well-known healthcare IT authority, reports on the latest regulatory news coming out of Washington, D.C.The Coding Report: Laurie Johnson has an update on the deadly coronavirus that continues to dominate international as well as domestic news headlines.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc. and Talk Ten Tuesdays co-host, will return to the broadcast to report on another thought-provoking topic that has captured her attention.

The 1,000-bed USNS Comfort, a hospital ship that in the past has provided humanitarian relief around the world, is now anchored on Pier 90 in Manhattan to provide humanitarian relief as COVID-19, the illness caused by the novel coronarvirus, ravages New York City, now the epicenter of the pandemic. Also in New York City, the famed Jacob Javits Center has been converted to a 1,200-bed field hospital by the U.S. Army Corps of Engineers. In the meantime, the White House is warning the nation to expect the worst, reporting that up to 200,000 deaths from COVID-19 could occur. As President Trump put it, “this is going to be a very, very painful two weeks.”The broadcast includes the following updates, and then segue to the town hall:Alvin Gore, MD, CHCQM, is a physician advisor and director of utilization management at St. Joseph Health in Sonoma County, Calif, and also a member of the board of directors of the American College of Physician Advisors;Matt Lambert, MD, an emergency medicine doctor and the chief medical officer (CMO) for Curation Health;Dennis Jones, administrator of patient financial services for Montefiore Nyack Hospital in Nyack, N.Y., and a frequent panelist on Monitor Mondays and Talk Ten Tuesdays; andHoward Stein, DO, MHA, CHCQM-PHYSADV, associate director of medical affairs and a senior physician advisor at CentraState Health System in Freehold, N.J.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on pending legislation in response to the 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, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

During this of Monitor Mondays, senior healthcare analyst Frank Cohen, a computational statistician, reports on how anecdotal thinking is not evidence-based thinking, and it is difficult to draw conclusions without having all of the information – noting that’s exactly what is happening right now, as America grapples with the coronavirus (COVID-19).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel files her Monitor Mondays RAC Report.Audit Report: Sean M. Weiss, reports on the next audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick, has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright reports on current healthcare legislation – proposed, pending, or passed – and its intended consequences.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment which he discusses swing beds, Telehealth and billing under COVID19.

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

With more cases of the novel coronavirus (COVID-19) being reported in countries outside of China, where the deadly virus has claimed the lives of a reported 2,771, world health leaders are preparing for a global pandemic that will provide a tsunami of health information for use by governments, world health agencies, and researchers, to hopefully control the future spread of the disease, develop vaccines, and share new learning to prevent future outbreaks.That’s a good thing. But what about the privacy of that health information? Even in a crisis, health practitioners have a responsibility to protect privacy, which is a matter of trust between health professionals and the patient/consumer. And that is why we asked Lorraine Fernandes, president of the International Federation of Health Information Associates (IFHIMA), to report on this crucially important healthcare issue.The live broadcast will also feature these other segments:RegWatch: Stanley Nachimson reports on the latest regulatory news coming out of Washington, D.C.The Coding Report: Laurie Johnson has an update on the deadly coronavirus that continues to dominate international as well as domestic news headlines.Tuesday Focus: March 1 through 7 is National Sleep Awareness Week, and that is why we asked Dr. Nick van Terheyden to report on the importance of sleep. News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Kathy Pride, senior vice president of coding and documentation services for Panacea Healthcare will discuss a current topic that’s surfaced on her radar.

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

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

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

Practice Function, Inc., a unit of Allscripts Healthcare Solutions Inc., engaged in an "abhorrent" scheme to help a pharmaceutical company push its extended-release opioids, according to a news release posted on Monday by the U.S. Department of Justice.The company agreed to pay $145 million to resolve criminal and civil investigations relating to its electronic health records (EHR) software. Practice Fusion admitted soliciting and receiving kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications. Famed whistleblower attorney Mary Inman reports our lead story this edition of Monitor Mondays.Other segments to be featured on the podcast include:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.IRF Report: Angela Phillips, considered to be among the nation’s most recognized authorities on inpatient rehabilitation facilities (IRFs), provides a 2020 update on the many changes taking in place in the IRF world.SDoH Report: Ellen Fink-Samnick, has the latest news on social determinants of health (SDoH) and also conduct the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

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

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

2020 ushers in a formidable decade of healthcare regulations and a perilous audit landscape, populated with aggressive auditors who will be aided by artificial intelligence to review and deny claims.Decisions being made in Washington, D.C. will impact every practice, facility, and health system. With so many major changes taking place, you need to stay informed and alert – and RACmonitor and Monitor Mondays will help you stay out in front of the issues that will alter the delivery of healthcare, both now and through this new and unchartered decade.Monitor Mondays host and RACmonitor Publisher Chuck Buck will have the following all-star lineup of experts on hand to tell you what to watch out for in 2020, during the first broadcast of the year for the weekly Internet broadcast, which is celebrating 10 years of live programs. Our line up of panelists includes:Dr. Ronald Hirsch, MD, FACP, CHCQMNancy Beckley, MS, MBA, CHCKnicole Emanuel, Esq.Maureen Testoni, Esq.Stanley Nachimson, MSEdward M. Roche, PhD, JDAndrew Wachler, Esq.Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPAngela M. Phillips, PTWilliam A. Dombi, Esq.Leslie Marsh, RN, BS, MSN, MBA

Join us for a unique look behind the scenes with long-time Monitor Mondays moderator Clark Anthony as he interviews many of our esteemed panelists from the last 10 years.

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

Rural hospitals are an endangered species in America, with extinction a real possibility. In fact, the North Carolina Rural Health Research and Policy Analysis Center report that more than 120 hospitals have closed nationwide since 2005, with nearly 70 percent (or 83) of those closures occurring since 2010. Adding insult to injury is the recent announcement from the Centers for Medicare & Medicaid Services (CMS) that Monday, Dec. 2 is the deadline for critical access hospitals (CAHs) to submit a hardship exception to avoid the “Medicare downward payments.” To qualify, those hospitals must illustrate the use of certified electronic health record technology (CEHRT) in order to meet the reporting requirements of the Medicare Promoting Interoperability Program and demonstrate “meaningful” use.Delivering a State of the Union report on America’s rural hospitals during this edition of Monitor Mondays will be Maggie Elehwany, vice president of government affairs and policy for the National Rural Health Association.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel will report on the latest activities by the Recovery Audit Contractors (RACs), and other third-party Medicare claims auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Court Report: The U.S. Supreme Court recently turned away two cases that tested the scope of the False Claims Act. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon.Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.“CMS has spent the last two years working on the IMPACT Act, and they are now ready to implement,” reports Mary Beth Pace, vice president of care management at Trinity Health. “Does the CoP resemble anything akin to what you thought they would come out with? It does not to us. Let me reflect on our initial shock, and then our action.”For a field report on how one major health system is preparing for this major new policy, RACmonitor has invited Ms. Pace to be the special guest during the next edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel will report on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six defendant managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Fraud Report: The manager of multiple medical clinics in Brooklyn and Queens, New York, was found guilty for his role in a nearly $100 million healthcare kickback and money laundering scheme, according the U.S. Department of Justice. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon. Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Patient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care. Reporting the lead story during this episode of Monitor Mondays is Melinda Battaile, MD, physician advisor and clinical documentation advisor for Vidant Health in Greenville, N.C.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs).Monday Focus: Algorithms are a trending topic, made even more so with recent accusations of gender bias in the Goldman Sachs Apple Card leveled by presidential candidate and U.S. Senator Elizabeth Warren. RACmonitor investigative reporter and New York attorney Ed Roche returns to the broadcast to continue his reporting on algorithms and their use in claims auditing.Policy Update: The Centers for Medicare & Medicaid Services (CMS) intends to press forward with payment cuts for some hospital clinic visits, as well as cuts to the 340B drug discount program, despite an adverse court ruling in September. Matthew Albright, chief legislative affairs officer for Zelis, reports on this developing story. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on CMS's final rule’s reference to “shoppable” services. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.The new rulemaking this so, 52 CFR, Section 424.519, Disclosures of Affiliations, authorizes CMS to deny or revoke enrollment based on disclosures of certain affiliations the agency determines to pose an undue risk of fraud, waste, or abuse.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates. Mr. Wachler also discusses what constitutes an “affiliated entity” and what events must be disclosed.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Court Report: Famed whistleblower attorney Mary Inman reports on Tenet Healthcare’s proposed $66 million False Claims Act settlement. Inman is a partner in the London office of Constantine Cannon.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Giant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.The results of a study published last week by Science revealed what researchers identified as a "significant racial bias" in Optum’s algorithm, which reportedly undervalues the healthcare needs of black patients. Although Science didn’t mention Optum by name, other news organizations have confirmed that it was, indeed, Optum.Reporting on this developing story during this edition of Monitor Mondays is RACmonitor investigative reporter and New York attorney Edward Roche, director of business intelligence for Barraclough New York LLC.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Ring of Fire: Dr. Alvin Gore, the physician advisor at St. Joseph Health in Santa Rose, Calif., reports on disaster planning in the wake of horrific wildfires burning out of control in Northern California. Shortages of nurses who were ordered to evacuate is one of the many emergencies he continues to monitor as the fire rages.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Monday Rounds: Substituting for Dr. Ronald Hirsch, is Dr. Howard Stein, associate director of medical affairs and physician advisor in care management at CentraState Medical Center in Freehold, New Jersey.

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

Acts of Congress plus regulatory cuts by the Centers for Medicare & Medicaid Services (CMS) are estimated to reduce federal payments to hospitals by $256.6 billion from 2010 to 2029, according to a study released this week and commissioned by the American Hospital Association (AHA) and the Federation of American Hospitals.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.War on Drugs: Famed whistleblower attorney Mary Inman, partner at the London law office of Constantine Cannon, reports that major drug manufacturers and distributors are proposing deals that could be worth up to $50 billion to help resolve the nationwide litigation of the pharmaceutical industry’s liability for America’s opioid crisis. SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Resources from Ellen Success over Stress, DePaul University Grant, Robert Wood Johnson Foundation Grant to Purpose Built Communities, CVS FundingRisky Business: Healthcare attorney David Glaser will return to Monitor Mondays with his trademark segment in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

There have been recent media reports of layoffs and pay cuts among the ranks of those working in the nation’s skilled nursing facilities (SNFs) as a result of the new Medicare reimbursement model from the Centers for Medicare & Medicaid Services (CMS): the Patient-Driven Payment Model.Reporting on these new changes during this edition of Monitor Mondays will be Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy. The new PDPM system reverses the financial incentives that existed for 20 years. Instead of paying more money for more minutes of therapy that a resident at a SNF receives, the new system pays less for residents who receive therapy. Ms. Edelman will discuss how the reimbursement system has changed, and what residents and their families can do to try to ensure that patients continue to receive medically necessary therapy.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Washington Report: President Donald Trump’s recent executive order tweaking the Medicare system continues to roil healthcare stakeholders. Reporting on the ongoing fallout is Matthew Albright, chief legislative affairs officer for Zelis Healthcare and former CMS official.Monday Focus: New York attorney and RACmonitor investigative reporter Ed Roche returns to the broadcast to report on the use of artificial intelligence in Medicare audits, as announced in the President’s executive order.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers. HHS Proposes Stark Law Anti-Kickback Statue ReformsMonday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment. Medical Conservative

As expected, the Governor of Virginia, Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Wednesday, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.The suit was filed by the Potomac Law Group.During this edition of Monitor Mondays, healthcare attorney Knicole Emanuel, a partner in the aforementioned law firm and a member of the RACmonitor editorial board, provides an update on the lawsuit as it makes its way through the court system.Also covered in this edition of Monitor Mondays:SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Monday Focus: A listener reports that Noridian (Jurisdiction F), rather than providing any diagnosis codes for non-dialysis usage, insists on having five scenarios provided in order to determine if an order meets guidance criteria. Attorney and physician Dr. John Hall weighs in on this topic, which seems to have entangled front desk staff, schedulers, and physicians.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Other segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports our lead story on the mass terminations of behavioral healthcare providers in Virginia. Emanuel has also been at ground zero in Richmond this past week, representing the aforementioned association there. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Monday Focus: Physician advisors should spend their time talking to doctors, not reviewing records and writing lengthy status determinations, according to Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., returns to the broadcast to report on the consequences that arise when internal physician advisors merely sit behind their computer screens, to the exclusion of interactions with other physicians. Risky Business: Healthcare attorney David Glaser continues his reporting on the dramatic and long-awaited outcome of the recent court decision involving AsceraCare – a decision that appears to make it difficult to make a False Claims Act case based on physician judgment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Time is running out for skilled nursing facilities (SNFs). Come Oct. 1, 2019, time will be a thing of the past for such providers, as there will be a new payment methodology for SNFs: The Patient-Driven Payment Model (PDPM). Under PDPM, reimbursement for Medicare Part A patients in SNFs will be driven by patient condition, rather than by therapy minutes provided. Documentation is crucial to avoid a Recovery Audit Contractor (RAC) audit. Reporting our lead story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel. Other segments to appear during the live broadcast include the following:CMS Report: The Centers for Medicare & Medicaid Services (CMS) is cracking down on bad actors: past and present fraudsters. Author, educator, and consultant Duane Abbey, president of Abbey and Abbey Consultants, Inc., reports on CMS efforts to identify those who are or have been affiliated with illegitimate providers.Surprise Balance Billing: While it once appeared to be a done deal leading into the August recess for members of Congress, legislative action on surprise balance billing has stalled out as stakeholders and lawmakers struggle with the details. An update on this now-contentious issue is presented by Matthew Albright, chief legislative affairs officer for Zelis Healthcare and former CMS official.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has latest news on this trending topic that is attracting significant media attention. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Do you know the statutory and regulatory requirements to avoid jeopardizing payment for you and your skilled nursing facility (SNF)?You need to know because the Recovery Audit Contractors (RACs) and other contractors are reviewing SNF referrals. Reporting our lead story is physician and attorney John K. Hall, founder of the Aegis Firm. Hall reviews such statutory and regulatory requirements while also making recommendations for audit readiness.Other segments to appear during the broadcast:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report the latest audits by RACs and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Hurricane Watch: Dr. Daniel Zirkman, the chief physician advisor at CarolinaEast Medical Center in New Bern, N.C., reports on how his facility prepared for Hurricane Dorian, which forced the mandatory evacuation of nearly 400,000 residents in that state. SDoH Report: Marvin D. Mitchell, Director of Case Management and Social Services at San Gorgonio Memorial Hospital in Banning, Calif., east of Los Angeles, reports on how to operationalize social determinants of health (SdoH) concepts.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Two suicides, and a provider-driven into bankruptcy – and all because two ex-employee criminals looking for some fast cash lied to the state under the pretext of being whistleblowers tipping off Medicaid auditors, creating a cascade of unbelievable tragedy. RACmonitor Editorial Board member, investigative reporter, and New York attorney Edward Roche returns Monitor Mondays with this exclusive story about a durable medical equipment (DME) provider facing auditors who, in his words, had gone rogue.Other segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.The Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on a controversial decision made last week, when U.S. District Judge David Ezra, sitting in Texas, dismissed a whistleblower’s complaint alleging that an executive with Baylor University Medical Center created an upcoding scheme to overcharge Medicare.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. See Ellens Survey ResultsRisky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Obtaining an injunction in federal court to lift a suspension of access to Medicare or Medicaid funds is rare, according to healthcare attorney Knicole Emanuel. As she was preparing to file such an injunction in federal court recently, the prepayment review suspension was lifted. Emanuel, a partner in the Potomac Law Firm and a regular panelist on Monitor Mondays, reports on the possible reasons that might explain such a mystery during this edition of Monitor Mondays.Other segments to appear includes:IRF Report: Angela Phillips, considered to be one of the nation’s foremost authorities on inpatient rehabilitation facilities (IRFs), reports on the final rule for the IRF prospective payment system for the 2020 fiscal year.The Court Report: Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, reports on a $57 million fraud scheme that involved laundering money through a hospital.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The Center for Medicare Advocacy (CMA) is reporting news about a new payment structure for home care, noting that such a plan is likely to adversely affect a hospital’s ability to acquire home care services for some patients. One of the factors to determine the payment to a home care agency for an episode of care is the origin of the patient, with two rates – one for the community, and one for the institution – and obviously, the referral from the community will have a lower payment. Judith A. Stein, JD, executive director of the Center for Medicare Advocacy, reports on this story, along with William Dombi, Esq. president of the National Association of Home Care and Hospice, during this edition of Monitor Mondays.Other segments to appear during the live broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, and will report on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Reports of payer abuse continue unabated, and among the worst offenders cited by physician advisors are Aetna, Humana, and UnitedHealthcare.Case in point: When a physician advisor recently challenged an Aetna medical director about an observation payment, the medical director didn’t have an answer, but retorted by simply saying “whatever is in our contract.”This is but one example of Medicare Advantage (MA) plans misusing commercial guidelines and making up their own rules, as they see fit, in order to avoid paying hospitals equitably for the care they provide to their members. Reporting on this development during this edition of Monitor Mondays is Steve Phillipson, Director of Hospital Medicine at Aspirus Wausau Hospital, in Wausau, Wis.Other segments to appear during the live broadcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Monday Focus: Marvin D. Mitchell, Director of Case Management and Social Services at San Gorgonio Memorial Hospital in Banning, Calif., east of Los Angeles, reports on the potentially adverse issues associated with “copy-and-paste” functionality in electronic medical records (EMRs).SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

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