Podcasts about racmonitor

The national conference of the largest regional coding organization chapters in America's healthcare universe gets underway this weekend – and James S. Kennedy, MD, will be there.Dr. Kennedy, president of CDIMD, a national coding and clinical documentation integrity (CDI) consultancy, will be reporting on major events taking place at the California Health Information Association (CHIA) conference, starting this weekend in Southern California.As a longtime editorial contributor to RACmonitor and ICD10monitor, Dr. Kennedy, will be the special guest during the next live edition of Talk Ten Tuesdays, coming up at 10 a.m. EST on June 3. The Internet broadcast, produced by ICD10monitor, is expected to feature the additional following instantly recognizable panelists, who will report more news during their segments:•Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH;•CDI Report: Cheryl Ericson, Director of CDI for the vaunted Brundage Group, will have the latest CDI updates;•The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will report on the latest coding news;•News Desk: Timothy Powell, ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk; and•MyTalk: Angela Comfort, veteran healthcare subject-matter expert, will co-host the long-running and popular weekly Internet broadcast. Comfort is the Assistant Vice President of Revenue Integrity for Montefiore Health.

Welcome to a strange new world.Recent tariffs announced by the Trump Administration are likely to impact drug manufacturing, since many drug components are produced outside the U.S., in nations such as in India, giving rise to state laws. Many states limit overseas involvement relative to the Health Insurance Portability and Accountability Act (HIPAA). Florida, for example, prohibits the offshoring of certain patient data, requiring such storage to be within the U.S.Responding to this emerging crisis, the producers of RACmonitor and Monitor Mondays have invited Lexi Morrison, director of operations at MedPharma, to be the program's special guest during the next live edition of the venerable Internet broadcast, coming up at 10 a.m. EST on Monday, May 19.The long-running broadcast will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

A flurry of national news reports continues to document the large-scale restructuring taking place at the U.S. Department of Health and Human Services (HHS), where 10,000 jobs were reportedly slashed earlier this month, a move also impacting the workforce at the Centers for Medicare & Medicaid Services (CMS). An estimated 300 CMS workers are expected to be affected by this action, while NPR reported that the HHS teams focusing on sexual violence prevention were also eliminated – on the first day of April's Sexual Assault Awareness Month.Also recently, RACmonitor and Monitor Mondays have come into possession of a CMS memo, dated March 5, in which the agency warns that it may take action to prevent hospitals and other providers suspected of using “dangerous chemicals and surgical mutilation of children” relative to gender dysphoria, which the agency claims have “proliferated.” In fact, other executive actions taken by the Trump Administration also appear to have anticipated deleterious impacts on the health of America's LGBTQ+ population.It seems part of an overarching theme in which the Administration is waging social wars using gutted federal agencies more as a weaponized tactic than as a mechanism to serve the public.Reporting this story during the next live edition of Monitor Mondays will be physician Drew Updike, a recognized leader in hospital utilization management, denials, clinical documentation integrity (CDI), coding, and hospital operations.The long-running broadcast will also include these instantly recognizable features:• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Monday Rounds: Dr. Shaemarke Magan, medical director for CaroMont Health in Gastonia, North Carolina, will make his Monday rounds, substituting for Dr. Ronald Hirsch.

No matter the approach one might take for debridement, wound care continues to be an attractive source for audits – they inevitably arise and fester. Case in point: Wachler and Associates, a prestigious law firm in Michigan, currently is representing clients in some 18 wound care audit cases.That is why RACmonitor, producers of Monitor Mondays, has invited Andrew “Drew” Wachler, founder of Wachler & Associates, to be the special guest during the next live edition of the venerable weekly Internet broadcast.The long-running broadcast will also include these instantly recognizable features:• Breaking News: Famed whistleblower attorney Mary Inman, partner at Whistleblower Law, will report about a False Claims Act (FCA) settlement involving a Medicare Advantage provider.• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on congressional action taking place in Washington, D.C.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

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

Earlier this week, in the wake of the inauguration of President Donald Trump, a major announcement was made that some hope will lead to new advances in healthcare: “Stargate,” a private venture to build in the U.S. hyperscale data centers for artificial intelligence (AI). The strategic goal is to make the United States the world's leader in AI.Larry Ellison, founder of the relational database company Oracle, indicated that much work in this project will be focused on healthcare, including the promise of better medical diagnostics and imaging, personalized medicine, remote monitoring, and telehealth for patients, according to Edward M. Roche, RACmonitor investigative reporter, whose day job is director of scientific intelligence for Barraclough New York LLC.Roche will be reporting this lead story for the next edition of the long-running Monitor Mondays weekly broadcast.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, senior government affairs liaison for Zelis, will report on current healthcare legislation.

New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine patients' medical records for diagnoses that risk-adjust, nudging doctors to approve them up to a year after the patient visits, all while pocketing up to 20 percent of the additional revenue generated for Independent Health by these unsupported diagnoses.Reporting the lead story during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, partner in the law firm Whistleblower Partners.More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here and in RACmonitor.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, senior government affairs liaison for Zelis, will report on current healthcare legislation.Register now to listen to this exclusive news edition of Monitor Mondays; all this and more will be coming up at 10 a.m. EST on Jan. 13, 2024.

It's raining recovery auditors.More denials. More grief. More lost revenue and more palpable anxiety.The seemingly unending war between payers – private and public – and providers continues unabated. The ubiquitous Two-Midnight Rule and the contentious subject of observation versus inpatient status have become an indelible part of America's healthcare system.And that is why the producers of RACmonitor have dedicated the next live edition of the venerable Monitor Mondays Internet broadcast to be the go-to source for the latest audit and regulatory news: a veritable feast of valuable information for you and your team to use.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Substituting for Dr. Ronald Hirsch will be Dr. Tripti Katari, who will be making her Monday Rounds. Dr. Katari is expected to report on updates on the American Medical Association (AMA), which she serves as Legislative Counsel.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, senior healthcare legislative affairs analyst for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The panic was widespread. Rumors were flying. Cellphone alarms were sounding.From large hospital conference rooms to upholstered cubicles, everyone seemed to have the same sense of disbelief and mounting frustration: Acentra Health (previously Kepro) had announced a new appeal process for Medicare patients – specifically, those whose status changed from inpatient to observation.Among those who maintained a sense of composure was healthcare regulatory guru Ronald Hirsch, MD.Dr. Hirsch, a popular presenter on Monitor Mondays, produced by RACmonitor, carefully read the documents and concluded that while no one in healthcare wanted to be burdened with another Medicare form, the news was much less dire than it had first seemed.That is why the ICD10monitor producers of the popular Talk Ten Tuesdays Internet radio program invited Dr. Hirsch to report on his analysis of the new Medicare appeal process.Also as part of the broadcast, these instantly recognizable panelists will report more news during their segments:• The Coding Report: Christine Geiger, Assistant Vice President of Acute and Post-Acute Coding Services for First Class Solutions, will continue with the final installment in her three-part series on the significant changes in the newly released ICD-10 codes.• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH.• News Desk: Timothy Powell, ICD10monitor national correspondent and regulatory expert, will anchor the Talk Ten Tuesdays News Desk.• TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.Tune in to Talk Ten Tuesdays live on LinkedIn, or sign up below to join our email list for exclusive access to our live streaming platform.Cozen O'Connor Public Strategies - The Beltway BriefingListen for of-the-moment insider insights, framed by the rapidly changing social and...Listen on: Apple Podcasts Spotify

What's wrong with this picture?With more than 10 years of the Centers for Medicare & Medicaid Services (CMS) Two-midnight Rule now behind us, one would presume that most healthcare professionals should know what determines an inpatient status. But some don't.That is why RACmonitor has invited renowned physician and attorney Dr. John K. Hall to report on the requirements and risks associated with inpatient order documentation during the next edition of Monitor Mondays.Other segments during the weekly Internet broadcast will include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

A comprehensive new survey featuring responses from more than 1,500 U.S. patients reveals that they are not only frustrated by poor provider support, but also are experiencing tangible health setbacks – especially when waiting to refill prescriptions and being placed on hold while waiting to speak to a caregiver.Israel Krush, CEO and Co-Founder of Hyro, the healthcare vendor whose company sponsored the survey, is scheduled to be the special guest during the next live edition of the long-running Internet broadcast Monitor Mondays, produced by RACmonitor.Hyro's “Voice of the Patient” survey and accompanying report highlight significant gaps between patient needs and the current support available through healthcare delivery channels.Other segments during the weekly Internet broadcast will include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

A deep dive into microbiology can reveal an up-close look at the cells that make up organs of the human body – and corresponding cancer treatments that leave no trace of damage.The science of medicine appears to be moving at the speed of light lately. But will new healthcare technologies be audit-proof? Monitoring these escalating changes and their impact on America's delivery of healthcare services during the next live edition of Monitor Mondays will be RACmonitor investigative reporter Edward M. Roche.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Clarrisa Barnes, MD, President and CEO for the American College of Physician Advisors, is substituting for Ronald Hirsch to report on her Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The arms race is heating up.On one side there are healthcare providers, and on the opposing side, an army operated by the auditors. Who will be the winners and losers?Are you safe? And how do you protect your facility from claim denials and takebacks, especially when auditors are using artificial intelligence (AI)?RACmonitor investigative reporter Edward M. Roche will return to Monitor Mondays this coming Monday to report on the escalating AI arms race. Roche, who just completed an exclusive three-part series for RACmonitor on AI auditing, will also report on essential steps you and your colleagues can deploy in defense of such audits.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Artificial Intelligence (AI) software is now in the “hype phase” of adoption.It promises to increase the efficiency of medical audits. But also, AI is being touted as being able to handle much more data, examine many more cases, and instantly make decisions regarding medical necessity or inadequate documentation.The number of audits can be doubled, tripled, quadrupled. Why take samples for review when AI can audit every single claim submitted? Providers can expect a deluge of demands for recoupment, all delivered with exquisite and compelling prose.But is AI as accurate or as thorough or efficient as promised? During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will review basic defense strategies that providers can deploy against such audits, and look into the future to uncover some of the problems on the horizon.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Bart Daniels, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Legislative Update: Cate Brantley, senior government affairs liaisons for Zelis, will report on current healthcare legislation.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Many of America's hospitals continue to be challenged as it pertains to complying with the requirements from the Centers for Medicare & Medicaid Services (CMS) for implementing the agency's rule on hospital price transparency. And that is why RACmonitor and Monitor Mondays are producing a three-part series, in collaboration with ClaraPrice, to help providers fix this vexing problem, including addressing the onerous requirement for hospitals to produce their own machine-readable files (MRFs).Specifically, CMS is requiring hospitals to display their standard charge information in a CMS template layout, following data specifications and a data dictionary.But there's even more stringent requirements from CMS that providers also must address.During the next live edition of Monitor Mondays, Jory Hatton, ClaraPrice CEO, will continue with the second part of this essential series to help ease the pressure to comply.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

What happens if the Supreme Court of the United States (SCOTUS) dismantles decades of government agency discretion? Recent cases at SCOTUS indicate that this could happen. But what would be the consequences?During the next live edition of the long-running Internet radio broadcast Monitor Mondays, RACmonitor's own physician and attorney Dr. John K Hall will consider the ramifications of the demise of the so-called “Chevron Deference” currently enjoyed by federal agencies.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on current healthcare legislation.

What happens if the Supreme Court of the United States (SCOTUS) dismantles decades of government agency discretion? Recent cases at SCOTUS indicate that this could happen. But what would be the consequences?During the next live edition of the long-running Internet radio broadcast Monitor Mondays, RACmonitor's own physician and attorney Dr. John K Hall will consider the ramifications of the demise of the so-called “Chevron Deference” currently enjoyed by federal agencies.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on current healthcare legislation.

The implementation of generative artificial intelligence (AI) in the Electronic Health Record (EHR) is one of several hot-button issues to be explored during the next live edition of the Monitor Mondays, the long-running Internet broadcast produced by RACmonitor.Other high-level considerations to be reported include leveraging AI in regulatory compliance, creating physician notes from doctor-patient conversations, and how AI could bridge knowledge gaps.Reporting on these latest developments in healthcare technology will be senior healthcare consultant Sharon Easterling. Since 2012, Easterling has played a pivotal role in supporting companies as they integrate natural language processing (NLP) and machine learning into their coding and clinical documentation integrity (CDI) technology, utilizing algorithms. During the broadcast, her focus will be more sharply focused on advancing initiatives within healthcare AI and leveraging AI technology.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, federal legislative analyst for Zelis, will report on current healthcare legislation.

Will the World Health Organization (WHO) be given the power to impose restrictive pandemic measures on countries, including the United States? Will it be legally binding? What are the challenges and opportunities for healthcare providers in the United States, and how will this be enforced?The member states of the WHO have been working on a plan of action when faced with the next pandemic. Negotiations are underway now, and their outcome will be submitted to the 77th WHO Assembly in May.RACmonitor investigative Edward M. Roche will report the latest on this possible international compliance issue during the next live edition of Monitor Monday. Broadcast segments will include these instantly recognizable features:· Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. · The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·  Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment. · Legislative Update: Cate Brantley, state legislative analyst for Zelis, will report on current healthcare legislation. · Lead Story: RACmonitor investigative reporter Ed Roche will report on potential international compliance rules in the event of another global pandemic.

No more eggnog. Toss the champagne bottles. The good times are over, and now it's back to business. But not business as usual. As the rest of the nation's healthcare professionals clocked in for overtime, claims auditors were scrutinizing medical records, looking for the slightest inconsistency upon which to pounce. Now, nearly four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here and in RACmonitor.Broadcast segments will include these instantly recognizable features:·Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  · Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment. · Home Care and Hospice: William Dombi, president and CEO for the National Association for Home Care and Hospice, will report on the latest news concerning Medicare home health and hospice but also Medicaid's Home & community-based services (HCBS). ·Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation. ·Docs and Regs: Monitor Mondays' own physician and attorney, Dr. John K. Hall, will report on the impact of artificial intelligence on healthcare. · Tech Report: RACmonitor investigative reporter Edward M. Roche will report on the latest technology trends impacting America's healthcare delivery system. · Lead Story: Frank Cohen, founder of the Frank Cohen Group will report on his recent study about how major changes to the 2021 evaluation and management (E&M) services is impacting 2024 E&M coding and compliance.

RACmonitor investigative reporter Edward M. Roche, an intrepid regular monitor of America's healthcare system, will return to Monitor Mondays for its next upcoming edition to report on how and why America's healthcare system has tied itself into a Gordian Knot of complexity: interwoven strands of conflicting rules and regulations, different payments for the same services, and a cumbersome patchwork quilt of facilities, big, small, and smaller. Roche, who recently introduced to Monitor Mondays listeners the concept of “smart hospitals,” will also take a stab at answering a key question: just how smart are they?Other broadcast segments will include these instantly recognizable features:• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief leglistative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

So far in October, the U.S. Department of Justice (DOJ) has been very busy, securing settlements, pleas, and convictions ranging in value from $25 to $350 million.And just this month, DOJ announcements have featured settlements related to Anti-Kickback and Stark violations, as well as convictions in genetic testing schemes and guilty pleas for fraud involving unnecessary testing.During the next live edition of Monitor Mondays, RACmonitor's own physician and attorney, Dr. John K. Hall, will break down some of these recent reports to give you additional insights and help you understand your own risk.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Coinciding with National Breast Cancer Awareness Month (October), RACmonitor investigative reporter Edward M. Roche recently went to the laboratories of Memorial Sloan Kettering to investigate one of the most exciting scientific developments of the decade.Roche, who was among the first to introduce the healthcare compliance world to algorithms, artificial intelligence (AI), and “smart” hospitals, said that the molecular biological approach to cancer treatment represents a true scientific breakthrough. He also recounted the three standard treatment stages in America's efforts to combat breast cancer: surgery, radiation, and chemotherapy. Each of these treatments, according to Roche, can have substantial and sometimes devastating side effects. Now, developments in molecular biology carry the potential to sweep away these approaches and leave patients healthy with a bare minimum of discomfort. But the question remains: when all is said and done, will America's healthcare insurance companies reimburse providers for these services?Roche will outline these issues as the featured guest during the next live edition of Monitor Mondays.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

The United States spends more money on healthcare than any other country in the world. In 2021, U.S. healthcare spending reached $4.3 trillion.Medicare, which insures seniors, is America's largest national health program, and therefore, it can and should be compared to its counterpart in other countries. So, how does the United States stack up?How do outcomes in the United States compare for patients, and what kind of comparisons can we make from the point of view of the healthcare provider? Do doctors have it better in the United States, or in other places? What lessons can we learn? Where are the most urgent areas that need reform?During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will examine U.S. healthcare in comparison with that of other countries, focusing on a number of dimensions, including cost, quality, outcomes, and ease of use.Broadcast segments will include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Lead Story: RACmonitor investigative reporter Edward M. Roche will report the lead story on the performance scorecard for Medicare.

The fall season is just about here. Colorful autumn leaves will be becoming ubiquitous, like claims denials and audits. And in this season, now is the time to “git ‘er done.”And Monitor Mondays is the place to do it.In preparation, following the long Labor Day weekend, RACmonitor producers of Monitor Mondays have enlisted the services of some of the most trusted and respected names in regulatory compliance and claims auditing. And joining this panel of experts in the long-running Internet broadcast will be a new voice added to the lineup: Angela Jordan, currently executive vice president of Calm Waters AI, Inc., specialists in evaluation and management (E&M) leveling services.Broadcast segments will include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on the latest legislative actions that will impact the healthcare regulatory setting.E&M Update: Angela Jordan, executive vice president for Calm Waters AI, Inc., will report on the latest twists and turns associated with the omnipresent E&M services impacting physicians and physician groups.

The Centers for Medicare & Medicaid Services (CMS) FY2024 Inpatient Prospective Payment System (IPPS) Final Rule, posted on Aug. 1, reveals changes to the MS-DRG, CMS Hospital Acquired Conditions, and CMS Inpatient Quality Reporting Program affecting inpatient revenue cycles, quality reporting, and reputations essential to hospital operations. There are plenty of audit hazards. And that's why RACmonitor invited James S. Kennedy, MD, a nationally recognized clinical coding authority, to be our expert tour guide during the next live edition of Monitor Mondays to identify potential risks and opportunities effective on October 1, 2023.  Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.The RAC Report: Healthcare attorney Cara Ludwig, substituting for Knicole Emanuel, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, a legislative analyst for Zelis, will report on current healthcare legislation.

There is a buzz swirling within the healthcare auditing community. And thanks to RACmonitor investigative reporter Edward M. Roche, the news is buzzworthy.According to Roche, a legal team has developed two arguments that can be used by healthcare providers in federal court after the Administrative Law Judge (ALJ) process is completed. One argument is based on constitutional rights, while the other is a contradiction between the Medicare Program Integrity Manual and adopted federal law.During the next live edition of Monitor Mondays, Mr. Roche will discuss these two arguments briefly, and issue a call for providers who are at this stage in their appeals and might be interested in someone taking up their case on a contingency basis. Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Cate Brantley, state legislative affairs analysis for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

“Hospitals may be the most complex organizations in the world,” writes Edward M. Roche, scholar, United Nations consultant, and RACmonitor investigative reporter. “They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals.”Roche, who will be the featured panelist during the next live edition of Monitor Mondays, believes that hospitals, in their quest for stability, have been nonetheless traumatized by the COVID-19 epidemic and a suffocating regulatory environment. Roche will also report on how many American hospitals now are in the midst of a digital transformation that is leading to an era of “smart hospitals” that will deliver unparalleled integration and improvements in all aspects of healthcare.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

Why the confusion and the apparent uptick in denials by Managed Care Organizations (MCOs) for skilled nursing facility (SNF) transfers?Returning to report on this vexing topic during the next live edition of Monitor Mondays will be Ben Kartchner, MD, a physician advisor who will join the broadcast to present the final installment in his two-part series being produced by RACmonitor and Monitor Mondays.Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors, exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with newly gained knowledge from the broadcast, including the actual medical necessity requirements for SNF transfers.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Mary Beth Pace, vice president of Trinity Health, will be making her Monday Rounds, substituting for Dr. Ronald Hirsch.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.AgriFutures On AirThe official podcast channel for AgriFutures Australia. Listen on: Apple Podcasts Spotify

Medical necessity denials for skilled nursing facility (SNF) transfers by Managed Care Organizations (MCOs) are increasing at an astonishing rate.The reason seems to be a lack of understanding of the difference between skilled and non-skilled care. During an exclusive two-part series being produced by RACmonitor and Monitor Mondays, Ben Kartchner, MD will delve into this complex topic that is generating buzz, especially among physician advisors, many of whom appear to be struggling with post-acute care (PAC) and, specifically, SNF services. In fact, Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with newly gained knowledge from the broadcast, including the actual medical necessity requirements for SNF transfers.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Legislative Update: Adam Brenman, a legislative analyst for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.AgriFutures On AirThe official podcast channel for AgriFutures Australia. Listen on: Apple Podcasts Spotify

In May 2022, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a report claiming that 25 percent of Medicare patients experienced adverse events during their October 2008 hospital stay.“That's a staggering number,” said John K. Hall, MD, in an email to RACmonitor. “So, what does it mean, and what should providers expect from other auditors and government agencies?”During the next live edition of Monitor Mondays, physician and attorney Dr. Hall will review the report and offer suggestions to prepare if the OIG comes knocking at your door.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.LiveStream Chat: Dr.John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

No more eggnog. Toss the champagne bottles. The good times are over, and now it's back to business. But not business as usual.As the rest of the nation's healthcare professionals clocked in for overtime, claims auditors were scrutinizing medical records, looking for the slightest inconsistency upon which to pounce. Now, nearly four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You'll hear auditing news you won't find anywhere else – except here and in RACmonitor.Broadcast segments will include these instantly recognizable features:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds, during which he will report an exclusive auditing story in which he details news about a move by the Centers for Medicare & Medicaid Services (CMS) to clamp down on Medicare Advantage (MA).The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.Legislative Update: Cate Brantley, a federal legislative analyst for Zelis, will report on current healthcare legislation.Docs and Regs: Monitor Mondays' own physician and attorney, Dr. John K. Hall, will report on how revisions to water down the Medicare Program Integrity Manual tend to increase liability for providers.Tip Sheet: RACmonitor investigative reporter Edward M. Roche will have another jaw-dropping story about audits, auditing, and a dismal outlook for 2023.Live Stream Chatting: Dr.John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning's top stories.

Join Dr. Andrew Tisser and guest Dr. Ronald Hirsch as they discuss what a Physician advisor is, its duties and responsibilities, and why it is an essential role in the hospital. Dr. Hirsch shares that a physician advisor determines the correct admission status for the patient so that the hospital gets paid for the care, the physicians get paid for the care, and the patients are in the correct status. From that, it grew into involving a whole bunch of other things. One of the most significant duties now with physician advisors is to work with the Clinical Documentation Integrity Team, working with medical terms and teaching doctors how to use them properly. In addition, they stand as case managers, especially in complex cases like disagreements between family members and physicians, where they act as a neutral body to read the chart and help the family understand what's happening. So, if you want to learn more about this fantastic career, tune in and enjoy!In this episode, you will learn:·       Dr. Ronald Hirsch's background·       What is a physician advisor?·       The process of becoming a physician advisor.·       The importance of having a physician advisor·       His advice to early career physicianAbout Dr. Ronald Hirsch:Leader in health care quality and management with a particular focus on Inpatient and Outpatient care and Centers for Medicare and Medicaid Services (CMS) regulations. Board certified by the American Board of Quality Assurance and Utilization Review Physicians with Physician Advisor sub-specialty designation. Member of the Advisory Boards of the American College of Physician Advisors (ACPA) and the National Association of Healthcare Revenue Integrity (NAHRI). Fellow of the American College of Physicians and the American Board of Quality Assurance and Utilization Review Physicians.Co-author of The Hospital Guide to Contemporary Utilization Review, published by HCPro. Editorial Board member of RACmonitor.com with a weekly segment on Monitor Monday. Course director for Athena Forum. Internal Medicine residency at Kaiser Permanente Medical Center in Los Angeles, CA. Board-certified in Internal Medicine.Been a keynote speaker at multiple conferences but would never put that in my title line. Connect with Dr. Ronald Hirsch:LinkedIn: https://www.linkedin.com/in/ronald-hirsch-md-facp-chcqm-chri/Connect with Talk2Medoc on:Website:          https://www.andrewtisserdo.com/LinkedIn:         https://www.linkedin.com/in/andrewtisserdo/Facebook:       https://www.facebook.com/andrew.tisserInstagram:       https://www.instagram.com/talk2medoc_llc/Twitter:                        https://twitter.com/Talk2MeDoc

Are Medicare auditors similar to ancient hunting parties roaming the tundra for wild game? Are audits applied equally and randomly across all healthcare providers, or is there intelligent design directed by a  hidden network of influencers, working behind the scenes and shifting first to one area, then another?During the next live edition of Monitor Mondays, Edward M. Roche, RACmonitor's investigative reporter, is going to look at the data to see if there are patterns in auditing and settlements – and if possible, identify the drivers behind these waves of aggressive activity.Other segments will include these instantly recognizable broadcast features:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.SDoH Report: Tiffany Ferguson, a subject-matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

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

“Good enough for government work,” was once the saying among cynical factory workers. And yet today in healthcare, precision in Medicare statistical analysis really matters. If overpayments are found, then the extrapolation recoupment number will go up; if underpayments are found, the extrapolation will go down.Listen and learn during the next live edition of Monitor Mondays when RACmonitor investigative attorney Edward M. Roche will report that his team routinely finds Medicare auditors handing in extrapolations that can be plus or minus 10, 15, 20, 30 percent –  or even worse.“That is somewhere between 25 and 85 percent,” wrote Roche recently in RACmonitor. “But that seems to be good enough for government work.”Precision in Medicare auditing is a prerequisite. But, sadly—as you'll learn from Roche—that's not always the case.Other segments will include these instantly recognizable broadcast segments:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

Medicare Advantage Audits, Establishing Medical Necessity to Ensure Payments, and the Two-Midnight Rule are three outstanding RACmonitor webcast topics discussed by Dr. John Zelem and Chuck Buck in this current episode of Front and Center.

Nearly $3 billion in expected recoveries have surfaced in the spring 2022 Semiannual Report to Congress by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). As reported by RACmonitor's Mark Spivey, the OIG report also provides an overview of the watchdog's activities from Oct. 1, 2021 through March 31, 2022. During the next live edition of Monitor Mondays, providing comment and context to the report, which was published Monday, June 6, will be prominent healthcare attorney Andrew “Drew” Wachler, a longtime OIG observer and the managing partner at Wachler and Associates. Other segments will include these instantly recognizable broadcast segments: The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors.  SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.  Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

Like fine wine, problem lists age very well. Too well, in fact.Such lists can remain in place for months, even years, without being updated. And questions can lead to conflicts and errors.Too often, problem lists simply languish, with unchanged patient encounter information. Moreover, even when a problem does appear on the problem list, it doesn't necessarily signal that the provider addressed the issue during the patient encounter.During the next live edition of Monitor Mondays, Dr. Andrew Markiewitz, a physician advisor and member of the RACmonitor editorial board, will delve deep into the root causes of problems in the problem list.Other segments will include the following:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs).SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Legislative Update Cate Brantley, a legislative analyst at Zelis, will report on current healthcare legislation.

Too many times, and in too many cases, providers are being subjected to flaws in methodologies and calculations used by auditors that lead to recoupment demands and other penalties.Aided by ambiguously written rules from the Centers for Medicare & Medicaid Services (CMS), unscrupulous auditors are often able to pounce on unsuspecting providers, wreaking havoc on revenues and human resources. The toll can be devastating. Monitoring on a daily basis providers' concerns and questions, RACmonitor and Monitor Mondays both report on these cases, bringing to light auditors' errors of commission and omission.During the next live edition of Monitor Mondays, trusted subject matter experts will report on the following:The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs).The Whistleblower Report: Famed whistleblower attorney Mary Inman will report that the U.S. Department of Justice (DOJ) is joining a whistleblower lawsuit against Modernizing Medicine and a co-founder, alleging violations of the False Claims Act involving the company's electronic health records (EHR) and kickbacks to physicians. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on current healthcare legislation. SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will return to the broadcast to report on the news that's happening at the intersection of healthcare regulations and the SDoH.  

The latest essential webcasts by RACmonitor are “Payer Contracts: Keys to Increasing Your Leverage,” led by Tiffany Ferguson and Marie Stinebuck, and the perennially popular on-demand webcast, “Implantable Device Credit Reporting and Outlier Payments: Audits Reviving up in 2022.” Both are given high marks in this current episode of Front and Center.Great topics. Great analysis. More great educational opportunities now await you. So now get everyone on your team Front and Center.Use code FRONTANDCENTER  for 15% off your RACmonitor webcast purchases.

It has been more than 10 years since Richard Bagnall filed suit against Kathleen Sebelius, in her role as Secretary of the U.S. Department of Health and Human Services (HHS). Since then, the case has been recaptioned several times, and bounced back and forth between the U.S. District Court for Connecticut and the U.S. Court of Appeals for the Second Circuit. But the class-action suit, now known as Barrows v. Becerra, finally now has a decision from the latter.RACmonitor's physician and attorney, John K. Hall, will return to the Monitor Mondays broadcast to report on whether the decision is reason for you to get excited – or just shrug.Other segments to be featured during the live broadcast include the following:Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on current healthcare legislation.SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.

Medicare Advantage audits and spinal procedures relative to the Inpatient-Only List are two outstanding RACmonitor webcast topics discussed by Dr. John Zelem and Chuck Buck in this current episode of Front and Center.

These complimentary special edition podcast from RACmonitor features Chuck Buck and John Zelem, MD as they review on-demand webcasts as well as preview upcoming webcasts. Dr. Zelem offers a unique physician perspective as he explains to listeners key learning objectives from these educational webcasts.Visit RACmonitor.com to view more informational webcasts

The story first broke here on RACmonitor, when investigative reporter Edward M. Roche wrote about a case of double-dipping: the act of an auditor sampling and extrapolating against the same set of claims.As Roche explained in his exclusive RACmonitor article, the practice is like receiving two traffic tickets for a single instance of running a red light. The practice doubles the amount of recoupment demanded. Providers pay twice.During the next live edition of Monitor Mondays, Roche will report on this unseemly practice in general, but will also provide an update on this very same case now coming up for review by an Administrative Law Judge (ALJ).Other segments to be featured during the live broadcast include the following:Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former 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, who stepped down recently as the Monitor Mondays and RACmonitor subject matter expert on the social determinants of health (SDoH), will return to the broadcast for a one-time-only appearance, sitting in for Tiffany Ferguson. 

It's an amazing spectacle being played out on network television news, talk radio, and cable news outlets: the tug-of-war between the Biden Administration and the Supreme Court. So, the question remains: when is a mandate not a mandate?  The back-and-forth over the Centers for Medicare & Medicaid Services (CMS) vaccine mandates for a wide range of healthcare providers has reached a conclusion, at least temporarily. After recent oral arguments, the Supreme Court has reinstated these CMS mandates. As such, RACmonitor's and Monitor Mondays' own Dr. John Hall, an attorney and physician, will have an important update and practical recommendations to help ensure that your facility is in compliance during the next edition of the weekly Internet radio broadcast. Other segments to be featured during the live broadcast include the following: Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that's happening at the intersection of healthcare regulations and the SDoH.

With the calamitous year of 2021 now in the rearview mirror, slowly receding from view, its legacy is expected to have a haunting effect, now and in the future, on America's system of healthcare. And decisions being made in Washington, D.C. will impact every practice, facility, and health system for months or even years to come.With so many major changes expected to take place in 2022, 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 unprecedented uncertainty.During the next edition of Monitor Mondays, broadcast 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 2022 premiere for the weekly Internet broadcast, which is celebrating 12 years of live programs.Segments to be featured during the live broadcast include the following:Coronavirus Update: Frontline physician Dr. John Foggle will provide a real-time update on the mysterious omicron, the extraordinarily contagious variant of the coronavirus that has gripped the nation.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.Medicare Advantage Report: Medicare Advantage (MA) auditors are being called, by some, nothing short of bullies. Senior vice president of clinical and regulatory affairs for Versulas Health, will report why this bulling behavior exists and how providers should deal with this ongoing issue.IRF: One of the nation's foremost authorities on inpatient rehabilitation facility (IRF) services, Angela Phillips will return to report on the resumption of IRF reviews by Recovery Audit Contractors (RACs).The Special Report: Who really does own the medical record? Dr. John Zelem, founder and CEO for Streamline Solutions Consulting, will report on this controversial issue, seeking to perhaps finally resolve the decade-old mystery.The Roche Report: RACmonitor investigative reporter Edward C. Roche will return with an exclusive story he's uncovered while monitoring audit misbehavior nationwide from his perch in the Big Apple.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: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will make her Monitor Mondays debut appearance, filling the shoes of Ellen Fink-Samnick, who has long reported on this timely topic with clarity and insight, but will be leaving her post as she completes her doctorate degree. Ferguson will report on the news that's happening at the intersection of the coronavirus and the SDoH.

The auditing never stops, and the pace is quickening. New issues, new audits.But what are the costs for hospitals seeking to avoid audits? In one of the most comprehensive reports of its kind ever offered, RACmonitor and Monitor Mondays will bring on board prescient thought leaders to define the contours of this deepening healthcare regulatory crisis. During the next edition of Monitor Mondays, our very own physician-attorney John Hall will report on the Centers for Medicare & Medicaid Services (CMS) vaccine mandate that almost happened, along withwhat this means, what you need to do, and, of course, how it might be audited.The latest Comprehensive Error Rate Testing (CERT) report revealed more than $25 billion in improper payments. And that means that providers and suppliers will have their processes and documentation audited further. Former Recovery Audit Contractor (RAC) Medical Director Robert Glenn, MD will report on how RACs utilize similar techniques to identify audit targets.What are the costs for hospitals trying to protect themselves from these audits? Maggie Shi, a PhD candidate at Columbia University, will share her doctorial thesis using mathematical modeling that may be beyond the comprehension of some.We'll also report on the latest national audit news updates from well-respected broadcast consultants, including:RAC Report: Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.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 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.

Using artificial intelligence (AI), along with an uncanny ability to misinterpret rules, Medicare auditors – specifically, third-party auditors of Medicare Advantage (MA) plans – are ever-ready to pounce on healthcare providers. And too often, it's like shooting fish in a barrel.The recent posting of three final rules will give auditors ample opportunity to search for more inadvertent errors on Medicare claims. Last week, as reported by RACmonitor, the Centers for Medicare & Medicaid Services (CMS) posted final rules on the same day for the Medicare Physician Fee Schedule (MPFS), the Outpatient Prospective Payment System (OPPS), and the Home Health Prospective Payment System (HHPPS).More rules = more audits.It'll be the area of focus during the next edition of Monitor Mondays, which will also have the latest national audit news updates from well-respected broadcast consultants, including:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.Special Report: RACmonitor investigative reporter Edward M. Roche will continue with the second installment in his three-part series that for the first time is showing how auditors can skew the universe of claims to be audited to their advantage by hiding zero-paid claims.RAC Report: 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 have the latest news on a trending topic that is attracting significant media attention. 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 latest healthcare regulatory news coming out of Washington, D.C.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.

The next three consecutive Monitor Mondays broadcasts will constitute an explosive series, exposing for the first time how auditors can skew the universe of claims to be audited to their advantage by hiding zero-paid claims.Learn about this outrageous behavior when RACmonitor investigative reporter Edward C. Roche presents the first edition of his three-part series that exposes wrongdoing that is penalizing providers and threatening their financial stability.Monitor Mondays will also have the latest national audit news updates from well-respected broadcast consultants, including:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.RAC Report: Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.