Monitor Mondays

AmerisourceBergen, one of the nation’s largest pharmaceutical wholesalers, must turn over records to pension fund shareholders probing to determine wrongdoing by the drug distributor’s board for the company’s multi-billion-dollar legal exposure from the nationwide opioid crisis.AmerisourceBergen was already facing two congressional investigations, plus a Drug Enforcement Administration (DEA) probe. Reporting on this developing story is famed whistleblower attorney Mary Inman, a partner in the London law office of Constantine Cannon.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick has the latest news on a report from NPR about life experience and income inequality in the U

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

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

It’s been a rough year for home health and hospice providers, especially in light of the fact that the Centers for Medicare & Medicaid Services (CMS) included a reduction in the base payment rate of 8.01 percent in the Patient-Driven Groupings Model (PDGM) of the 2020 Home Health Prospective Payment System Rate Update.Returning to Monitor Mondays is William Dombi, president of the National Association for Home Care and Hospice, who will provide a regulatory update for his association as its members prepare for another year of audits.Other segments to be featured on the broadcast include the following:Monday Focus: What are likely to be three major audit issues in 2020? Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reveals his pick of the top challenges you and your team will face in 2020.RAC Report: Healthcare attorney Knicole Emanuel reports on the latest activities by the Recovery Audit Contractors (RACs) and other third-party Medicare claims auditors. Emanuel, a member of t

Rural hospitals are an endangered species in America, with extinction a real possibility. In fact, the North Carolina Rural Health Research and Policy Analysis Center report that more than 120 hospitals have closed nationwide since 2005, with nearly 70 percent (or 83) of those closures occurring since 2010. Adding insult to injury is the recent announcement from the Centers for Medicare & Medicaid Services (CMS) that Monday, Dec. 2 is the deadline for critical access hospitals (CAHs) to submit a hardship exception to avoid the “Medicare downward payments.” To qualify, those hospitals must illustrate the use of certified electronic health record technology (CEHRT) in order to meet the reporting requirements of the Medicare Promoting Interoperability Program and demonstrate “meaningful” use.Delivering a State of the Union report on America’s rural hospitals during this edition of Monitor Mondays will be Maggie Elehwany, vice president of government affairs and policy for the National Rural Health Associatio

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.“CMS has spent the last two years working on the IMPACT Act, and they are now ready to implement,” reports Mary Beth Pace, vice president of care management at Trinity Health. “Does the CoP resemble anything akin to what you thought they would come out with? It does not to us. Let me reflect on our initial shock, and then our action.”For a field report on how one major health system is preparing for this major new policy, RACmonitor has invited Ms. Pace to be the special guest during the next edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel will report on the status of the Medicaid laws

Patient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care. Reporting the lead story during this episode of Monitor Mondays is Melinda Battaile, MD, physician advisor and clinical documentation advisor for Vidant Health in Greenville, N.C.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs).Monday Focus: Algorithms are a trending topic, made even more so with recent accusations of gender bias in the Goldman Sachs Apple Card leveled

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.The new rulemaking this so, 52 CFR, Section 424.519, Disclosures of Affiliations, authorizes CMS to deny or revoke enrollment based on disclosures of certain affiliations the agency determines to pose an undue risk of fraud, waste, or abuse.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates. Mr. Wachler also discusses what constitutes an “affiliated entity” and what events must be disclosed.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor edito

Giant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.The results of a study published last week by Science revealed what researchers identified as a "significant racial bias" in Optum’s algorithm, which reportedly undervalues the healthcare needs of black patients. Although Science didn’t mention Optum by name, other news organizations have confirmed that it was, indeed, Optum.Reporting on this developing story during this edition of Monitor Mondays is RACmonitor investigative reporter and New York attorney Edward Roche, director of business intelligence for Barraclough New York LLC.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board,

A federal court on Tuesday found that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced payments for hospital outpatient services delivered outside of hospitals in outpatient provider-based settings. The Centers for Medicare & Medicaid Services (CMS) could appeal the court’s decision on its site-neutral payment rule for hospital outpatient services. Score one for hospitals, but the war is far from over.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.E&M Coding Changes: Impending evaluation and management (E&M) changes for 20

Acts of Congress plus regulatory cuts by the Centers for Medicare & Medicaid Services (CMS) are estimated to reduce federal payments to hospitals by $256.6 billion from 2010 to 2029, according to a study released this week and commissioned by the American Hospital Association (AHA) and the Federation of American Hospitals.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.War on Drugs: Famed whistleblower attorney Mary Inman, partner at the London law office of Constantine Cannon, reports that major drug manufacturers and distributors are proposing deals that could be worth up to $50 bill

There have been recent media reports of layoffs and pay cuts among the ranks of those working in the nation’s skilled nursing facilities (SNFs) as a result of the new Medicare reimbursement model from the Centers for Medicare & Medicaid Services (CMS): the Patient-Driven Payment Model.Reporting on these new changes during this edition of Monitor Mondays will be Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy. The new PDPM system reverses the financial incentives that existed for 20 years. Instead of paying more money for more minutes of therapy that a resident at a SNF receives, the new system pays less for residents who receive therapy. Ms. Edelman will discuss how the reimbursement system has changed, and what residents and their families can do to try to ensure that patients continue to receive medically necessary therapy.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recov

The Centers for Medicare & Medicaid Services (CMS) reportedly will collect information from hospitals about the prices they pay for drugs through the 340B discount program.How will the information gathered by CMS be used, moving forward? And why is this action being taken by CMS? The agency has a history of attempted cuts to 340B reimbursement; the most recent such action by CMS occurred last December, after which a federal judge ruled against the move.Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health.Other segments featured on this episode include:Court Report: Federal law enforcement personnel recently took down a fraudulent scheme involving 35 defendants associated with telemedicine companies and cancer genetic testing laboratories. The defendants have been charged for their alleged participation in fraudulently billing Medicare more than $2.1 billion for CGx tests. Reporting this story is famed whistleblower attorney Mary Inman, a part

As expected, the Governor of Virginia, Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Wednesday, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.The suit was filed by the Potomac Law Group.During this edition of Monitor Mondays, healthcare attorney Knicole Emanuel, a partner in the aforementioned law firm and a member of the RACmonitor editorial board, provides an update on the lawsuit as it makes its way through the court system.Also covered in this edition of Monitor Mondays:SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Monday Focus: A listener reports that Noridian (Jurisdiction F), rather than providing any diag

Other segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports our lead story on the mass terminations of behavioral healthcare providers in Virginia. Emanuel has also been at ground zero in Richmond this past week, representing the aforementioned association there. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Monday Focus: Physician advisors should spend their time talking to doctors, not reviewing records and writing lengthy status determinations, according to Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., returns to the broadcast to report on the consequences that arise when internal physician advisors merely sit behind the

Time is running out for skilled nursing facilities (SNFs). Come Oct. 1, 2019, time will be a thing of the past for such providers, as there will be a new payment methodology for SNFs: The Patient-Driven Payment Model (PDPM). Under PDPM, reimbursement for Medicare Part A patients in SNFs will be driven by patient condition, rather than by therapy minutes provided. Documentation is crucial to avoid a Recovery Audit Contractor (RAC) audit. Reporting our lead story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel. Other segments to appear during the live broadcast include the following:CMS Report: The Centers for Medicare & Medicaid Services (CMS) is cracking down on bad actors: past and present fraudsters. Author, educator, and consultant Duane Abbey, president of Abbey and Abbey Consultants, Inc., reports on CMS efforts to identify those who are or have been affiliated with illegitimate providers.Surprise Balance Billing: While it once appeared to be a done deal leading int

Do you know the statutory and regulatory requirements to avoid jeopardizing payment for you and your skilled nursing facility (SNF)?You need to know because the Recovery Audit Contractors (RACs) and other contractors are reviewing SNF referrals. Reporting our lead story is physician and attorney John K. Hall, founder of the Aegis Firm. Hall reviews such statutory and regulatory requirements while also making recommendations for audit readiness.Other segments to appear during the broadcast:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report the latest audits by RACs and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Hurricane Watch: Dr. Daniel Zirkman, the chief physician advisor at CarolinaEast Medical Center in New Bern, N.C., reports on how his facility prepared for Hurricane Dorian, which forced the mandatory evacuation of nearly 400,000 residents in that state. SDoH Report: Marvin D. Mitchell, Director o

Despite an order from the U.S. District Court for the District of Columbia for the federal government to reduce the backlog of Medicare appeals, the requirements for victory in front of an Administrative Law Judge (ALJ) remain the same.During this edition of Monitor Mondays, David Mullens, a California healthcare attorney, will address some of those fundamentals.Other segments to appear during the podcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Court Report: Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, reports on the latest development in the False Claims Act lawsuit filed by Integra Med Analytics last year against Providence St. Joseph Health. Inman previously reported on this story last August, noting that Integra was seeking $188

Two suicides, and a provider-driven into bankruptcy – and all because two ex-employee criminals looking for some fast cash lied to the state under the pretext of being whistleblowers tipping off Medicaid auditors, creating a cascade of unbelievable tragedy.  RACmonitor Editorial Board member, investigative reporter, and New York attorney Edward Roche returns Monitor Mondays with this exclusive story about a durable medical equipment (DME) provider facing auditors who, in his words, had gone rogue.Other segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.The Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, reports on a controversial decision made last week, when U.S. District Jud

Obtaining an injunction in federal court to lift a suspension of access to Medicare or Medicaid funds is rare, according to healthcare attorney Knicole Emanuel. As she was preparing to file such an injunction in federal court recently, the prepayment review suspension was lifted. Emanuel, a partner in the Potomac Law Firm and a regular panelist on Monitor Mondays, reports on the possible reasons that might explain such a mystery during this edition of Monitor Mondays.Other segments to appear includes:IRF Report: Angela Phillips, considered to be one of the nation’s foremost authorities on inpatient rehabilitation facilities (IRFs), reports on the final rule for the IRF prospective payment system for the 2020 fiscal year.The Court Report: Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, reports on a $57 million fraud scheme that involved laundering money through a hospital.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of