Monitor Mondays

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.Leg

In a terse, matter-of-fact announcement, the U.S. Department of Health and Human Services (HHS) is promising “significant enforcement” if providers have not complied with rules surrounding the Provider Relief Fund (PRF).This time, HHS is focusing on whether hospitals that received PRF payments complied with the surprise billing provisions of the PRF terms and conditions. Providing an early defense warning of the imminent government audits during the next edition of Monitor Mondays will be healthcare attorney Andrew Wachler, managing partner of Wachler and Associates, who is expected to warn providers that these audits are likely just the beginning.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 popu

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

A growing number of drug manufacturers are imposing unlawful limits on 340B discounts, according to a newly released report by 340B Health. Currently, up to 13 such companies “just say no” to discounts for prescription drugs sold to safety-net hospitals and dispensed through community pharmacies.During the next live edition of Monitor Mondays, reporting on the findings of this new report released late last month will be Maureen Testoni, president and CEO for 340B Health. Testoni is expected to report on how these major manufacturers are having a deleterious impact on 340B hospitals, while at the same time possibly harming patients.The 340B program, established in 1992, allows these 340B providers to purchase outpatient drugs at a reduced cost and to use those savings to be invested in patient care.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

For many third-party Medicare auditors, the only rules they follow are their own, substituting personal preference for regulatory realities – and all in the name of claim denials. Every day in nearly every American hospital, health system, or physician practice, some dedicated healthcare professional asks, “how could they do this to us?”There is a rightful place for Medicare auditing. But too often, in too many instances, legitimate auditing takes a backseat to the arbitrary denial of claims. This week, during another live edition of Monitor Mondays, the most trusted subject-matter experts in healthcare regulation will come together to discuss the latest examples of auditing gone awry. And highlighting the role of the physician advisor, who often is asked to interpret regulations, will be Dr. Elizabeth Quinn, the National Physician Advisor Conference chair.Other segments to be featured during the live broadcast include the following:Risky Business: Healthcare attorney David Glaser, shareholder in the law offi

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

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: Ro

Public schools and facilities will be closed. Church bells will chime, while a number of flags will fly at half-mast.  Because in 1983, former Republican President Ronald Reagan proclaimed that the third Monday of January would forever be observed as Martin Luther King Jr. Day.This coming Monday, Jan. 17, Monitor Mondays will honor the slain civil rights leader with a special report recognizing efforts by various stakeholders to advance a variety of initiatives designed to improve health equity in America.Reporting on how communities of color can benefit from regulatory efforts by the Centers for Medicare & Medicaid Services (CMS) and related federal agencies will be Lenel James, a business lead for Health Information Exchange & Innovation for the BlueCross and BlueShield Association (BCBSA). Mr. James was formerly associated with the Region V Regional Health Equity Council of Department of Health and Human Services (HHS) Office of Minority Health. In addition, he previously served on the Board of the

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: F

The Medicare regulatory audit landscape is rapidly changing, putting providers, vendors, and suppliers at significant risk. And this risk is significantly increased if you’re not aware of the changes. The penalties are severe.The next weekly edition of Monitor Mondays will provide a comprehensive overview of this new forboding landscape and its features. For example, Medicare home health is moving quickly into the world of value-based purchasing. Beginning Jan. 1, 2023, all home health agencies will be subject to a national demonstration program that puts up to 5 percent of their revenue at risk by tying it to their patient care performance. Each home health agency will compete with all others to determine which providers get bonuses and which are financially penalized.We’ll also report on the latest news and most current updates. You’ll receive 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 fi

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

"It’s time to stop getting stuck thinking we have a square-peg-and-a-round-hole problem, and focus on the fact that 42 CFR codifies and makes it law that a Medicare Advantage plan, even though it has autonomy in its contract, cannot offer less benefits than Medicare. Medicare Advantage plans cannot have more restrictive guidelines than Medicare; they must at the very least adhere to the simplistic confines of traditional Medicare” – this according to Dr. Jerilyn Morrissey, who will make her debut appearance during the next live edition of the long-running Monitor Mondays broadcast.We’ll also report on the latest news and most current updates, offering you our early-warning alert system. You’ll receive 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 popu

The signs are ominous. New final rules have been published. All the auditors are there, ready to pounce. Warnings are being sounded. It’s a tsumani of audits.During the next live edition of Monitor Mondays, we’ll report on the latest news and most current updates, offering you our early warning alert system. You’ll receive the latest national audit news updates from well-respected broadcast consultants, including: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.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, n

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

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 com

Operating with virtual impunity, while relying on artificial intelligence, payor auditors have locked on to providers to deny claims that trigger audits.Acts of omission by providers are often deemed acts of commission in the eyes of auditors – and the audits often lead to recoupment. Even the slightest apparently innocuous action can trigger a cascade of negative reactions, including denials.  Even knowing of misconduct is a major problem. During the next live edition of Monitor Mondays, healthcare attorney and physician John K. Hall will continue his two-part series on the consequences of seemingly inconsequential errors, and “fraud” that could very well just be the byproduct of other actions.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

Once suspended by COVID-19, claim audits are now back on the frontburner – Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), and Medicare Administrative Contractor (MAC) audits, plus Targeted Probe-and-Educate (TPE) audits are the new (or renewed) normal. It’s open season on providers, which is why, in large measure, the next live edition of Monitor Mondays will feature reports on how audits now being conducted by governmental and third-party contractors are making America “Audit Nation.”Monitor Mondays will have the latest national audit news updates from well-respected broadcast consultants, including:Monday Rounds: Physician and attorney John H. Kall, substituting for Dr. Ronald Hirsch, will make his Monday Rounds, but also will begin a two-part series exploring the landmine liability faced by utilization management (UM) and compliance professionals. Hall is the founder of Aegis Consulting Services.RAC Report: Knicole Emanuel, a partner at the law firm of Practus, will file the

Big surprise. But not really.The Interim Final Rule (IFR) for the federal No Surprises Act, released last month, appears to offer bad news for out-of-network providers (OON), which does not come as a surprise to heathcare attorney Thomas Force, who will return to the Monitor Mondays broadcast.Force will explain, citing that the guidance is focused on what the bill defines as good-faith estimates for uninsured and self-pay patients, along with the Independent Dispute Resolution (IDR) process between providers, facililies, and health plans. Force contends that the IFR has left many questions unanswered, and appears to be written for the benefit of health plans and carriers. Listen during the next live edition of Monitor Mondays, when there will be new light shed on a simmering old issue: providers versus payors.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 ano

The heat is on.As reported by RACmonitor, Livanta, the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) auditor, has started sending out documentation requests for short-stay inpatient audits. For targeted hospitals, Livanta will select 30 inpatient admissions of Medicare beneficiaries whose length of stay (LOS) was either zero or one day within the prior three months.So beware. And be prepared. For context on this development, Dr. John Zelem will report on the use of Occurrence Span Code 72 during the next live edition of Monitor Mondays.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 A