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Monitor Mondays

Health & Wellness Podcasts

Join Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when you’re listening to the long-running and popular Monitor Mondays. Register to attend live here: https://event.webcasts.com/starthere.jsp?ei=1235505&tp_key=eae2082467

Join Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when you’re listening to the long-running and popular Monitor Mondays. Register to attend live here: https://event.webcasts.com/starthere.jsp?ei=1235505&tp_key=eae2082467

Location:

United States

Description:

Join Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when you’re listening to the long-running and popular Monitor Mondays. Register to attend live here: https://event.webcasts.com/starthere.jsp?ei=1235505&tp_key=eae2082467

Language:

English

Contact:

6512923419


Episodes

UnitedHealthcare Poised to Deny ED Claims

6/14/2021
UnitedHealthcare is the latest insurer to join the growing lineup of payors that want to second-guess patients and deny payment for emergency department (ED) services after they’ve been rendered. As reported here on Monitor Mondays last week, UnitedHealthcare plans to extend no coverage or limited coverage to ED claims, retroactively – including any claims the giant insurer deems non-emergent. Our own Dr. John K. Hall will report on this recent development during the next edition of the...

Duration:00:30:52

Quality Audits and Malpractice Suits: How 2021 E&M Guidelines Raise Medical/Legal Issues

6/7/2021
Are your physicians providing detailed documentation as they adhere the 2021 Evaluation and Management (E&M) Guidelines? Frank Cohen, senior healthcare analyst and director of business intelligence for DoctorsManagement, is concerned that they might not be – which, he believes, squarely puts them in an uphill battle, defending themselves from quality audits and potential malpractice suits. And Cohen has the numbers to back up his concerns, which he will share during the next live edition of...

Duration:00:29:56

What Happened to the ALJ Logjam?

5/24/2021
There was a time when the word “logjam” seemed to be synonymous with the Administrative Law Judge (ALJ) hearings conducted under the purview of the Office of Medicare Hearings and Appeals (OMHA). Today, by all accounts, hearings are being scheduled almost back-to-back, and attorneys are scrambling to represent their clients during unprecendented times. Preparing for a multi-million-dollar hearing on Tuesday, May 25 is Andrew Wachler, managing partner at Wachler and Associates – and the...

Duration:00:31:53

Audit Nation: The Growing Impact of Claims Auditing on Healthcare

5/17/2021
“Incoming!” are the typical dreaded shouts heard from soliders hunkered down in bunkers when shelling begins. Today, across America, you can hear the same cries when it comes to claims auditing. Audits are incoming. Third-party auditors, governmental auditors, even auditors from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) looking at COVID-related claims are incoming – and the onslaught is occurring in rural hospitals as well as big city health...

Duration:00:59:29

Audit and Regulatory News Roundup: OIG Audits Latest Development

5/10/2021
Several hospitals have now received audit notices from the HHS Office of Inspector General (OIG) for COVID-related claims. The OIG has begun auditing hospitals to “determine whether Medicare paid hospitals for these inpatient claims in accordance with federal requirements.” Make no mistake, the OIG is auditing provider billing, not payment. The OIG is not auditing Medicare Administrative Contractor (MAC) performance, according to physician and attorney John K, Hall, MD. Dr. Hall who will...

Duration:00:30:59

The Perpetual Appeals Machine: The ALJs and Medicare Appeals Council

5/3/2021
What percentage of administrative law judge (ALJ) decisions end up at the Medicare Appeals Council? What percentage of those decisions are reversed? These are important questions asked by a reader in response to a recent article written for RACmonitor by Frank Cohen, senior healthcare analyst and director of business intelligence for DoctorsManagement. Cohen, who has extensive experience as a subject matter expert in ALJ hearings, will look under the hood of the perpetual appeals machine,...

Duration:00:29:32

Knock, Knock. Who’s There? OIG Warns of COVID-19 Scammers

4/26/2021
They’re using text messages. They’re offering vaccination cards, and even COVID-19 testing. They’re scammers. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is currently warning that providers that charge impermissible fees must refund them, and ensure that individuals are not charged any sum at all, for the COVID-19 vaccine – along with warning of fraudulent telemarketing calls and even door-to-door visits. Of particular concern are scammers...

Duration:00:30:19

Blame the RACs for the ALJ Backlog

4/19/2021
With little in the way of reporting on the backlog of appeals at the Administrative Law Judge (ALJ) level, you could conclude that such hearings are on hiatus. But that’s not the case, according to senior healthcare consultant Frank Cohen, who will be reporting the lead story during the next live edition of Monitor Mondays. Cohen, director of business intelligence at DoctorsManagement, is expected to report that while he had testified at four ALJ hearings in all of 2019-2020, he has already...

Duration:00:30:40

Aging Bridges, Road and Patients: Infrastructure Pitch Comes with a Human Touch

4/12/2021
President Joe Biden’s roughly $2 trillion infrastructure proposal, called the “American Job Plan,” includes approximately $400 billion to expand access to home care and community-based services, including access to long-term care provided under Medicaid. Reporting on the impact of this possible new fusion of funding during the next edition of Monitor Mondays will be William Dombi, president of the National Association for Home Care and Hospice. No stranger to broadast listeners, Dombi’s...

Duration:00:31:21

Facing a Fourth Wave: COVID-19 Update

4/5/2021
The initiative to vaccinate enough Americans to achieve herd immunity against the deadly coronavirus appears to be stalling – this in the face of increases in infection rates. According to data from the Centers for Disease Control and Prevention (CDC), the country has experienced an average of 65,000 new cases in the last seven days. Reporting our lead story during the next edition of Monitor Mondays will be John Foggle, MD, who returns to the broadcast following his stint as a frontline...

Duration:00:31:24

Appealing Ridiculous DRG Denials: Rearranging Deck Chairs on the Titanic?

3/29/2021
“Ridiculous denials are frustrating. Vent, and then respond,” Dr. Andrew Markiewitz advises. “But ask: are you arguing over the Titanic’s deck chairs?” “Insurers may correctly identify unsubstantiated diagnoses,” Markiewitz added – and, if their findings are legitimate, return the money. If the DRG or reimbursement doesn’t materially change, after all, where’s the value? Fighting the fight worth fighting will be the topic of the next edition of Monitor Mondays, when Markiewitz, a physician...

Duration:00:30:41

National Regulatory and Audit News Update

3/22/2021
Healthcare data breaches and the possibility of sanctions from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) are a rightfully terrifying possibility for healthcare administrators. But one hospital, MD Anderson Cancer Center, recently fought back and won. Reporting on the outcome of the decision handed down by the 5th Circuit Court of Appeals during the next live broadcast of Monitor Mondays will be Dr. John K. Hall, a physician and attorney. Hall,...

Duration:00:30:04

Novel Legal Approaches to Defend Audits: Listen and Learn

3/15/2021
Now that the auditing reset button has been pressed, you and other providers can expect a torrent of audits and recoupments. In this new aggressive auditing environment, propelled by commercial as well as governmental auditors, providers must continually update their approach in response. Against this chaotic background, there’s a new legal approach to audit defense advocated by Wachler & Associates. During the next live edition of Monitor Mondays, prominent healthcare attorney Andrew...

Duration:00:31:41

Bed Hijacking: Outpatients Assigned to Inpatient Beds

3/8/2021
“Are your CFOs agitated by the increase of outpatients in inpatient beds because of the removal of total knee arthroplasty (TKA), total hip arthroplasty (THA), and hundreds of other procedures from Medicare’s Inpatient-Only List (IPO) list?” asked Julie Collins recently on the RAC Relief listserv. “If the surgeon’s office is securing the prior authorization, how are they doing with securing the proper classification (inpatient/outpatient)? Are they using a dartboard to determine which...

Duration:00:30:20

Regulatory News Roundup: Major Changes Underway by the New Administration

3/1/2021
Changes to the nation’s Medicaid program, which reportedly covers some 70 million people, are expected soon. According to news reports, among the looming changes is the elimination of the work requirement for Medicaid recipients. This will mark the featured topic during the next live edition of Monitor Mondays, when healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will report on this change and others that will affect providers. Other segments to be featured...

Duration:00:30:48

New Revelations Emerge Illuminating Misinterpretations of Condition Code 44

2/22/2021
After all this time, you could still be doing it wrong when it comes to Condition Code 44. If your hospital has been following the Medicare Condition Code 44 process associated with 42 CFR 482.30 because policy issued by the Medicare Advantage or commercial plans with which you’re contracted dictates its use, this may be the case, according to Dr. Juliet Ugarte Hopkins, the special guest during the next live edition of Monitor Mondays. Other segments to be featured during the live...

Duration:00:30:15

It’s All About Change: MCG and InterQual

2/15/2021
With the purchase by UnitedHealthcare (UNC) of Change Healthcare, providers are contemplating notable differences between two sets of quidelines. Change Healthcare owns InterQual criteria, while UHC has traditionally used MCG criteria. Becoming familiar with the variances in terms of observation timeframes, screening methodologies, severity of illness thresholds, and intensity of service thresholds for levels of care will be the topic reported on by Kelvin Valera, MD, a healthcare...

Duration:00:30:25

Exclusive: Medical Device Credits in OIG Crosshairs

2/8/2021
To ensure compliance in conveying device credits and to identify providers who do not, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has a specific Annual Work Plan item to address the matter. Either through targeted device credit audits or enveloped in broader general billing compliance regulations for hospitals and ambulatory surgical centers (ASCs), the OIG is clearly seeking to ferret out “noncompliers.” Adding fuel to the fire, the OIG also...

Duration:00:30:17

Billions in Overpayments Levied Against Providers by CMS; Uncovering Flaws in Methodology

2/1/2021
Billions of dollars in overpayments are levied annually against healthcare providers by the Centers for Medicare & Medicaid Services (CMS), based on the use of extrapolation audits. And while thousands of extrapolation audits are completed each year, the targeted provider or organization most likely will appeal the use of extrapolation. In nearly all cases, the appeal is focused on one or more flaws in the methodology used to create the sample and calculate the extrapolated overpayment...

Duration:00:29:59

COVID-19 News Update – The Mask Mandate

1/25/2021
Even as the nation continues to struggle with the coronavirus pandemic, President Joe Biden, who took office Thursday as the 46th President, signed executive orders mandating that masks be worn on federal property and for interstate travel on trains, transit systems, and airlines – this being part of the President’s agenda for the first 100 days in office. Meanwhile, shortages of the COVID-19 vaccine are being reported throughout the country, most notably in the Big Apple, where New York...

Duration:00:30:22