Monitor Mondays-logo

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://racmonitor.medlearn.com/racmonitor/podcasts/

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://racmonitor.medlearn.com/racmonitor/podcasts/

Language:

English

Contact:

6512923419


Episodes

The Medicare Report Card: Assessing Areas for Major Reform

9/18/2023
The United States spends more money on healthcare than any other country in the world. In 2021, U.S. healthcare spending reached $4.3 trillion. Medicare, which insures seniors, is America’s largest national health program, and therefore, it can and should be compared to its counterpart in other countries. So, how does the United States stack up? How do outcomes in the United States compare for patients, and what kind of comparisons can we make from the point of view of the healthcare provider? Do doctors have it better in the United States, or in other places? What lessons can we learn? Where are the most urgent areas that need reform? During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will examine U.S. healthcare in comparison with that of other countries, focusing on a number of dimensions, including cost, quality, outcomes, and ease of use. Broadcast segments will include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Lead Story:

Duration:00:30:49

Like Autumn Leaves, RAC Audits Keep Falling

9/11/2023
The fall season is just about here. Colorful autumn leaves will be becoming ubiquitous, like claims denials and audits. And in this season, now is the time to “git ‘er done.” And Monitor Mondays is the place to do it. In preparation, following the long Labor Day weekend, RACmonitor producers of Monitor Mondays have enlisted the services of some of the most trusted and respected names in regulatory compliance and claims auditing. And joining this panel of experts in the long-running Internet broadcast will be a new voice added to the lineup: Angela Jordan, currently executive vice president of Calm Waters AI, Inc., specialists in evaluation and management (E&M) leveling services. Broadcast segments will include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: E&M Update:

Duration:00:29:44

Assessing the Impact of Financial Woes Facing America’s Healthcare Providers

8/28/2023
First there was COVID-19, which seemed to have torn a gaping hole in our nation’s patchwork quilt of care facilities. Add to this the rising costs of everything that touches healthcare, and now the growing list of Chapter 11 bankruptcies rippling through nursing homes and other facilities that provide care for America’s seniors. But will the tentacles of this lengthening financial crisis reach down and strike at other similar facilities? Reporting our lead story during the next live edition or Monitor Mondays will be William Dombi, president and CEO for the National Association for Home Care and Hospice. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business:

Duration:00:31:04

Physician Advisors: Revenue Drag or Stimulant?

8/21/2023
Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business:

Duration:00:28:09

What’s So Smart About Smart Hospitals?

8/14/2023
Information technology has revolutionized many industries, including healthcare. “Smart” hospitals promise vast increases in productivity, and are being designed as integrated IT platforms linking together technology, patients, and providers in a complex web of interaction. But are the promised advantages of smart hospitals tangible, or are there a number of factors that may inhibit providers from obtaining the benefits that are promised? And how are things really measured? Edward M. Roche will discuss this high-growth area of expenditures, and go over both the accelerators and inhibitors of this transformation in healthcare. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update:

Duration:00:31:03

FY 2024 IPPS Final Rule: Looking Under the Hood for Hazards

8/7/2023
The Centers for Medicare & Medicaid Services (CMS) FY2024 Inpatient Prospective Payment System (IPPS) Final Rule, posted on Aug. 1, reveals changes to the MS-DRG, CMS Hospital Acquired Conditions, and CMS Inpatient Quality Reporting Program affecting inpatient revenue cycles, quality reporting, and reputations essential to hospital operations. There are plenty of audit hazards. And that’s why RACmonitor invited James S. Kennedy, MD, a nationally recognized clinical coding authority, to be our expert tour guide during the next live edition of Monitor Mondays to identify potential risks and opportunities effective on October 1, 2023. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update:

Duration:00:29:36

Proposed Expansion of Medicaid RACs Includes Focus on Managed Care Payments

7/31/2023
The Government Accountability Office (GAO) is recommending expansion of the Medicaid Recovery Audit Contractors (RACs) program, to include auditing of payments made to managed care organizations (MCOs), according to a GAO report released in June. Launched in 2011 as a consequence of the Patient Protection and Affordable Care Act (PPACA) by the Centers for Medicare & Medicaid Services (CMS), the Medicaid RACs were purported to be aggressive in their recouping of alleged Medicare Fee-for-Service (FFS) overpayments. They could now be poised to expand into the rapidly growing MCO plans. During the next live edition of Monitor Mondays, Dennis R. Jones, senior director of revenue cycle at Jefferson Health, will report on this developing story. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update:

Duration:00:31:07

New Developments for Defeating Statistical Extrapolations Revealed

7/25/2023
There is a buzz swirling within the healthcare auditing community. And thanks to RACmonitor investigative reporter Edward M. Roche, the news is buzzworthy. According to Roche, a legal team has developed two arguments that can be used by healthcare providers in federal court after the Administrative Law Judge (ALJ) process is completed. One argument is based on constitutional rights, while the other is a contradiction between the Medicare Program Integrity Manual and adopted federal law. During the next live edition of Monitor Mondays, Mr. Roche will discuss these two arguments briefly, and issue a call for providers who are at this stage in their appeals and might be interested in someone taking up their case on a contingency basis. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:29:09

$9 Billion Refund to 340B Hospitals at Risk

7/17/2023
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to remedy Medicare Part B pay cuts made to 340B hospitals by issuing a lump-sum repayment to affected facilities. Last year, the U.S. Supreme Court ruled that those cuts, implemented by CMS from 2018 through most of 2022, were unlawful. Consequently, CMS proposed to offset the refunds by reducing payments for non-drug services to all hospitals under the 2024 Outpatient Prospective Payment System (OPPS). Commenting on this latest development impacting 340B hospitals during the next edition of Monitor Mondays will be the president and CEO for 340B Health, Maureen Testoni. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:31:01

Enforcement and Penalties, Guardrails and Risks: Understanding the 21st Century Cures Act

7/10/2023
Although the 21st Century Cures Act was enacted in 2016, many hospitals today continue to struggle with effective implementation of its provisions and the goal of preserving patient access to medical records. Seven years later, however, meaningful guidance regarding its enforcement is here. One of the provisions requires developers not to engage in information blocking. Now that the guardrails are in place and the risks have been identified, Monitor Monday’s own physician and attorney Dr. John K. Hall will review the related enforcement actions and the penalties during the next live edition of the long-running Internet broadcast. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update:

Duration:00:30:29

The Big Worry. The Big Unwind: Medicaid Disenrollment Keeps Rolling Along

6/26/2023
At least 1.3 million Medicaid enrollees have been disenrolled as of June 20, according to the Kaiser Family Foudation (KFF) “Unwinding Tracker.” This estimate could be an under-count, KFF admits, due to state recordkeeping details. Yet the major issue looms on the horizon: what will happen to those who have lost their Medicaid benefits? Could a tsuansmi of patients without health insurance soon appear at your hospital? During the next live edition of Monitor Mondays, Tony DiLuca, principal at Physician and Tactical Healthcare Services, LLC (PATHS) and a member of the Pennsylvania Department of Health and Human Services (HHS) Fee-for-Service Subcommittee, will report on the unwinding process of the enrollment, along with current updates and best practices. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:29:44

How Suffocating Regulations Are Leading to Smart Hospitals

6/19/2023
“Hospitals may be the most complex organizations in the world,” writes Edward M. Roche, scholar, United Nations consultant, and RACmonitor investigative reporter. “They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals.” Roche, who will be the featured panelist during the next live edition of Monitor Mondays, believes that hospitals, in their quest for stability, have been nonetheless traumatized by the COVID-19 epidemic and a suffocating regulatory environment. Roche will also report on how many American hospitals now are in the midst of a digital transformation that is leading to an era of “smart hospitals” that will deliver unparalleled integration and improvements in all aspects of healthcare. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:30:33

How Staffing Shortages Increase Audits

6/12/2023
Healthcare organizations often face staffing shortages in their revenue cycle, adding to the pressure of ensuring proper claims processing. The Centers for Medicare & Medicaid Services (CMS), U.S. Department of Justice (DOJ), and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) have increased audits to reduce improper payments, using predictive modeling and artificial-intelligence (AI) tools. Risk-based audits rose by 28 percent and prospective audits by 32 percent in 2022. To ease the burden on revenue cycle management (RCM) teams, a combination of automation, analytics tools, and denial management software can be used for hybrid audits, reducing denials and increasing reimbursements. During the next live edition of Monitor Mondays, Ritesh Ramesh, CEO for MDaudits, will report on how, by leveraging people and technology, internal audits can be conducted faster, errors caught earlier, and staff can focus more on training and optimizing revenue. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:30:11

Running Afoul of Federal Regulations

6/5/2023
This week, a disgraced Elizabeth Holmes was seen in media clips walking in the company of two unidentified men. Evidently, Holmes, who was convicted of fraud for her blood-testing start up, Theranos, turned herself in at a minimum-security prison in Texas to begin an 11-year prison term. All this media coverage raises the question: how easy is it to run afoul of the government regarding a wide range of statutes and regulations? Moreover, how far do you have to go to actually get to prison? During the next live edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine some recent convictions and sentences to help you assess your risk – keeping in mind that there’s no parole from federal prison. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update:

Duration:00:28:40

Smart Strategies to Avoid Denials of SNF Transfers

5/22/2023
Why the confusion and the apparent uptick in denials by Managed Care Organizations (MCOs) for skilled nursing facility (SNF) transfers? Returning to report on this vexing topic during the next live edition of Monitor Mondays will be Ben Kartchner, MD, a physician advisor who will join the broadcast to present the final installment in his two-part series being produced by RACmonitor and Monitor Mondays. Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors, exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with newly gained knowledge from the broadcast, including the actual medical necessity requirements for SNF transfers. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:31:23

How to Avoid Managed Care Denials for SNF Transfers

5/15/2023
Medical necessity denials for skilled nursing facility (SNF) transfers by Managed Care Organizations (MCOs) are increasing at an astonishing rate. The reason seems to be a lack of understanding of the difference between skilled and non-skilled care. During an exclusive two-part series being produced by RACmonitor and Monitor Mondays, Ben Kartchner, MD will delve into this complex topic that is generating buzz, especially among physician advisors, many of whom appear to be struggling with post-acute care (PAC) and, specifically, SNF services. In fact, Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with newly gained knowledge from the broadcast, including the actual medical necessity requirements for SNF transfers. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:30:15

Compliance Risk and Revenue Loss: Practicing without Privileges

5/8/2023
Your medical staff office just notified you that a physician has been performing procedures without privileges for the past five years. No, it doesn’t happen all the time. But what should you do? Physician and attorney Dr. John K. Hall will walk you through the considerations and help you understand how much revenue might be in jeopardy during the next live edition of Monitor Mondays. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:28:50

Utilization and Billing: Reconciling Conflicts

5/1/2023
Hospital utilization and billing are notoriously challenging concepts for providers and case management staff because they frequently boil down to two, often conflicting points of view: what can be done per the rules, regulations, and contracts, and what should be done to provide the most effective care for a patient? In a world where process standardization is imperative to maintain health system viability, but also where the practice of medicine remains an art, teams need a broad understanding of medical necessity and billing rules. Join us during the next live edition of Monitor Mondays when Dr. Juliet B. Ugarte Hopkins reports on where you can give and take and how to parse out the varying shades of grey. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update:

Duration:00:30:15

The False Claims Act: Will it Live to See Another Day?

4/24/2023
The beleaguered False Claims Act, which traces its origins to the Civil War, came before the Supreme Court this past Tuesday, when the Court heard oral arguments in a consequential and closely watched case involving one of the Government’s most effective tools for fighting healthcare fraud. Specifically, the issue is whether and when a defendant’s contemporaneous subjective understanding or beliefs about the lawfulness of its conduct are relevant to whether it knowingly violated the Act. This case involves accusations that supermarket pharmacies Safeway and SuperValu overcharged Medicare and Medicaid for generic drugs by misrepresenting the usual and customary prices they charged for the drugs. During the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at the law offices of Constantine Cannon, will provide background and context on the case that the Court is expected to issue a ruling for in June, at the end of its term. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:28:42

Confronting Artificial Intelligence: Healthcare’s Next Major Disruptor

4/17/2023
Recent highly publicized advances in artificial intelligence forecast the elimination of at least 30 percent of the healthcare workforce (probably more), including all generalist physicians. The astonishing scalability of information technology suggests that one to three data centers will be able to deliver medical advisory services to the entire population of the United States, according to Edward M. Roche, who will be reporting our lead story during the next live edition of Monitor Mondays. Roche is expected to report that as a country, America will see the debilitating cost of much healthcare being delivered today reduced to pennies and for all practical purposes delivered free of charge. But, cautions, Roche, such a game-changer will not be put in place without much resistance. So, who will be the winners and the losers in this new era of AI-driven healthcare? Register now to listen Monday. Broadcast segments will also include these instantly recognizable features: Monday Rounds: The RAC Report: Risky Business: Legislative Update: The Wrapper:

Duration:00:30:53