Monitor Mondays

UnitedHealthcare (UHC) is putting providers on notice: Come Jan. 1, 2019, the industry giant will use the SEP-3 definition to determine if a diagnosis of sepsis is clinically validated, advising that the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score is to be used to determine if sepsis is present.  If reviewers find no SOFA score in the medical record, that could spell trouble – audit trouble. Reporting on this topic during this edition of Monitor Mondays is Edward Hu, MD, executive director of Inpatient Physician Advisor Services for the University of North Carolina Health Care System and president of the American College of Physician Advisors.The broadcast rundown also will include: The RAC Report: Healthcare attorney Knicole Emanuel reports on a flurry of new cases in which judges are ordering the government to refrain from recouping alleged overpayments until a hearing has been held. Immediate recoupments, currently allowable by law, fundamentally violate our country’s co