Monitor Mondays

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

With little in the way of reporting on the backlog of appeals at the Administrative Law Judge (ALJ) level, you could conclude that such hearings are on hiatus.But that’s not the case, according to senior healthcare consultant Frank Cohen, who will be reporting the lead story during the next live edition of Monitor Mondays. Cohen, director of business intelligence at DoctorsManagement, is expected to report that while he had testified at four ALJ hearings in all of 2019-2020, he has already testified at four so far this year, with four more between now and June – all pertaining to cases from 2014-2015. Ask Cohen why the Recovery Audit Contractors (RACs) are to blame for the backlog – his answer will be one you may not expect.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) offici

President Joe Biden’s roughly $2 trillion infrastructure proposal, called the “American Job Plan,” includes approximately $400 billion to expand access to home care and community-based services, including access to long-term care provided under Medicaid.Reporting on the impact of this possible new fusion of funding during the next edition of Monitor Mondays will be William Dombi, president of the National Association for Home Care and Hospice. No stranger to broadast listeners, Dombi’s appearance comes at a time when the nation continues to grapple with the coronavirus pandemic, which in turn has illuminated the need for keeping those with the greatest risk potential for the deadly virus in a home-care environment.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: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CM

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 broa

“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

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 offic

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: E

“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 c

Changes to the nation’s Medicaid program, which reportedly covers some 70 million people, are expected soon. According to news reports, among the looming changes is the elimination of the work requirement for Medicaid recipients.This will mark the featured topic during the next live edition of Monitor Mondays, when healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will report on this change and others that will affect providers.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

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

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

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 ne

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 inters

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 o

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), w

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 Test

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 tha

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, shar

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 contra

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 Eman