Monitor Mondays

The problem begins like a blip on the radar screen: a curious anomaly that gradually grows more menacing. That is what Andrew Hughes, MD, and Charles Locke, both at Johns Hopkins, are noticing: an uptick in denials related to level of care provided versus the level of care billed. The majority of the denials arise when documentation indicates that a patient is "stable for downgrade" and a transfer has been initiated but not yet effectuated due to a lack of an available bed, reported Dr. Hughes, who was the special guest on this edition of Monitor Mondays. Other segments to be featured on the broadcast include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, made his Monday Rounds with another installment of his popular segment. Whistleblower Update: Mary A. Inman, partner at Constantine Cannon's law offices in London, reported on the Aetna lawsuit filed against CVS Caremark accusing the pharmacy benefit manager of the giant retail pharmacy operation of imp