Monitor Mondays

The coronavirus winter surge is quickly approaching, and at a time when the United States is experiencing record numbers of daily positive COVID-19 tests, with corresponding increases in hospitalizations expected to follow. What the country needs now is for payers – both governmental and commercial – to reinstitute post-acute authorization waivers, since such waivers have largely expired. Currently, UnitedHealthcare, Aetna, and Anthem have no post-acute authorization waivers in place for any patients, including COVID-19 patients.Without these waivers, hospitals must again go through the authorization process for post-acute stays. Reporting our lead story during the next edition of Monitor Mondays will be Dr. Edward Hu, system executive director of physician advisor services for UNC Health in North Carolina. Other segments to be featured during the live broadcast include the following:Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast

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

Providers that received payments from the federal Provider Relief Fund will be required to file reports demonstrating their compliance with the terms and conditions of those payments.Reporting on this, our lead story during the next live edition of Monitor Mondays, will be healthcare attorney Andrew Wachler, managing partner of Wachler & Associates. Mr. Wachler will report on anticipated “hot spots” in the auditing of the use of these payments, including healthcare-related costs and lost revenue attributable to the coronavirus and expenses that have been reimbursed from other sources.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Audit Report: Sean M. Weiss of DoctorsManagement will return to the broadcast with

More payment cuts are being proposed by the Centers for Medicare & Medicaid Services (CMS) for next year, a move sure to impact the many hospitals participating in the 340B drug discount program, as described in the 2021 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule.Such proposed cuts are expected to reduce Medicare Part B drug payments to levels lower than in 2018, when the last round of cuts were made. Reporting our lead story during the next edition of Monitor Mondays will be Maureen Testoni, CEO for 340B Health. Also participating in the broadcast will be ICD10monitor national correspondent Timothy Powell, CPA, who will report on the expected financial impact of those proposed cuts to critical access hospitals (CAHs).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Special Report: Even though length of stay (LOS) continues to

The venerable topic of length of stay (LOS) has recently been generating buzz among healthcare professionals – so much so that we asked Stefani Daniels, founder and managing partner of Phoenix Management, to return to the weekly Monitor Mondays broadcast with an update, noting that the use of LOS has apparently declined.But is it still a valuable metric? And how might LOS be used today? This question becomes even more relevant as hospitals work to improve efficiencies, reduce costs, and perhaps, decrease LOS.Other segments featured during this episode include:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Special Report: The Centers for Medicare & Medicaid Services (CMS) Price Transparency Final Rule becomes effective Jan. 1, 2021. Frederick Stodolak, president and CEO of Panacea, will return to the broadcast to report on how providers should prepare now for this initiative by CMS mandating that hospitals disclose their price

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently closed in on more than 345 defendants charged with participating in scams involving more than $6 billion in alleged losses to federal healthcare programs.The takedown occurred in September, according to the OIG. Of that amount, approximately $4.5 billion was associated with telemedicine schemes. The action by the feds puts a spotlight on the growing use of telehealth as a consequence of the ongoing coronavirus pandemic.Reporting our lead story during this edition of Monitor Mondays is John K. Hall, an attorney and physician.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and the SDoH. El

The Centers for Medicare & Medicaid Services (CMS) has moved to stop Medicare Advantage Organization (MAO)-hired subcontractors from issuing “pseudo-denials” that require pseudo-appeals before the MAO considers the denial formalized.The practice is reported to be extremely widespread and used against non-contracted providers: small, often rural hospitals that tend to be more vulnerable to these tactics.Reporting our lead story during the next live edition of Monitor Mondays will be Lisa Banker, MD, formerly chief medical advisor for revenue integrity at CarolinaEast Health System. Dr. Banker led the effort to convince CMS of the need to issue a recent memo on this topic.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports the latest news that’s

The recent announcement by the Centers for Medicare & Medicaid Services (CMS)  that it will be “ramping up” audits are quickly becoming a reality for providers across the country. Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Unified Program Integrity Contractor (UPIC) auditors are going full steam ahead, using data and analytics to assess overpayments via automated reviews – and new language in UPIC letters paints an ominous picture for providers they deem non-compliant.Reporting the lead story during this edition of Monitor Mondays is Sean M. Weiss of DoctorsManagement, who addresses these issues and the steps necessary to ensure a level playing field.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social dete

The Centers for Medicare & Medicaid Services (CMS) will reimburse a greater number of relative value units (RVUs) associated with office-based evaluation and management (E&M) visits, the agency announced recently.In order to achieve budget neutrality, CMS will reduce the payment per RVU. With this change, CMS is allocating a larger proportion of its total spending to office-based physicians, at the expense of surgeons and hospital-based physicians.Here’s the rub: organizations that utilize RVUs in their physician compensation arrangements and continue to pay the same 2020 rates per RVU on the increased number of 2021 RVUs will experience a dramatic decline in operating income. Reporting our lead story during this edition of Monitor Mondays is Adam J. Klein, who heads ECG’s Financial Services practice.Other segments to be featured during the live broadcast include the following:Whistleblower Update: Famed whistleblower Mary Inman, partner in the law office of Constantine Cannon, returns to the broadcas

Unlike the Cold War arms race between the then-Soviet Union and the United States, today’s arms race is being fought before computer monitors, and in the deep corners of computer laboratories. And the weapon of choice: algorithms.This fierce fighting is taking place between auditors and providers, and the stakes are high: money. Lots of it.No stranger to chronicling the former Cold War arms race, Edward Roche, RACmonitor’s investigative reporter, returns to the Monitor Mondays broadcast to report on how algorithms created by payers tend to foster a camouflage of mediocrity for providers.Other segments to be featured during the podcast:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.Legislative U

In recent weeks, several major pharmaceutical manufacturers have taken actions that could lead to narrowing the 340B Drug Pricing Program, which provides outpatient drugs to safety-net hospitals, health centers, and clinics at discount prices. The savings are invested in care for patients with low incomes, living in rural communities.The actions by Eli Lilly, Merck, and Sanofi are being challenged by a coalition of safety-net providers, including 340B Health, which represents more than 1,400 340B hospitals. Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health, who will discuss why she is concerned by these actions by drugmakers.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report. SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on t

California is one of two states in the country that rewards whistleblowers for bringing forward information about private insurance fraud. A recent $24 million settlement with pharmaceutical giant Abbvie over the marketing of the company’s blockbuster drug, Humira, demonstrates the law’s effectiveness.The settlement agreement was reached last week following allegations that the company violated California’s Insurance Frauds Prevention Act. Abbvie agreed to the settlement despite continuing to deny any wrongdoing.On the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will provide details on this important news story.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report. SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), report

The omnipresent coronavirus pandemic continues to upend lives, from mundane occasions like grocery shopping to long-planned space exploration missions. The pandemic is manifesting itself from the halls of Congress to the cubicles at Centers for Medicare & Medicaid Services (CMS) headquarters, to classrooms, theatres, homes, and places of worship, among other venues.On the next live edition of Monitor Mondays, we will explore the impact of the coronavirus on audits and auditing, proposed rules, guidance, and waivers.Joining the broadcast to report on anticipated pandemic-related audits will be Dr. John K. Hall, founder of The Aegis Firm, a healthcare consulting firm. Dr. Hall, also an attorney, will discuss these types of scenarios, and how to prepare for the inevitable denials coming your way.Also during the 60-minute broadcast, you’ll hear from Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University, who will provide a much-needed perspective on

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

While the battle cry of “defund the police” has emerged from Black Lives Matter activists following the death of George Floyd at the hands of Minneapolis police, could there also be sufficient reason for providers to advocate to “defund the Unified Program Integrity Contractors (UPICs)?”According to RACmonitor investivative reporter Ed Roche, UPIC auditors are attacking osteopathic medicine, and might need lessons in reading patient notes. During the next live edition of Monitor Mondays, Roche will explore the seeming incompetence of auditors when they go after such providers. Osteopathic doctors help manage pain, but there may be no cure for an incompetent audit.Other segments to be featured during the live broadcast include the following:COVID-19 Report: Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University, will provide an update on the pandemic that claimed the lives of more that 152,000 in the U.S.Audit Report: Sean Weiss, compliance officer f

Two major storylines are discussed during this edition of Monitor Mondays, with the exclusive 60-minute broadcast to focus on the raging coronavirus pandemic and the imminent auditing of Medicare and Medicaid claims scheduled to begin Aug. 3, as directed by the Centers for Medicare & Medicaid Services (CMS).Joining the broadcast to report on the coronavirus will be Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University. Offering an update on the imminent audits of Medicare and Medicaid claims will be healthcare attorney Andrew Wachler, managing partner of Wachler and Associates. And Sean Weiss, chief compliance officer for DoctorsManagement, reports on the issues and implications associated with the public health emergency (PHE), which was extended recently by Alex Azar, Secretary of the U.S. Department of Health and Human Services (HHS).Two reports from two provider organizations will round out the Monitor Mondays coverage of the impact of the

Could Alexander VS. Azar really be over? This week's Monitor Mondays episode we've called upon or resident healthcare attorneys Knicole Emanuel Esq., David Glaser Esq. and our guest host John K. Hall MD, JD to dissect and assess the complicated case.The case has been disorganized since the beginning, possibly leaving more questions than answers. This Monitor Mondays round table will analyze procedural aspects of the case and what it could potentially mean for providers, analyze where the decision has risk for providers, and provide guidance of how providers should respond in the future.Other segments to be featured during the live weekly Internet radio broadcast include the following:SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest research from the Urban Institute and Robert Wood Johnson Foundation about Unemployment, and Loss of Employer-sponsored insurance. Ellen will also conduct the Monitor Mondays Listener Su

Last week, pharmaceutical giant Novartis paid $51 million to settle a Massachusetts suit about patient copay waivers. The DOJ press release notes that this is the 14th settlement of this kind to come from the Boston area. In related news, the Government brought a suit against Regeneron alleging that the company had a scheme of very well calculated charitable giving that steered patients to its macular degeneration drug, which costs $1,850 per dose, and away from a competitor’s drug, which costs $55 per dose.We are joined this week by Mary Inman, Esq. who has the latest on the Novartis suit and the FCA Allegations and how the court rules might have expensive ripple effects on the industry, and on drug prices.Other segments to be featured during the live weekly Internet radio broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social det

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

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