Podcast
Monitor Mondays
Hosted by RACmonitor · EN
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/
14episodes
Episodes
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Preventing Denials: The Role of Facility-Based Clinical Definitions
3d ago00:31:04Tap to summarizePayer-driven clinical validation is a common reason given by payers to remove ICD-10-CM/PCS diagnosis and procedure codes affecting reimbursement or quality-based payment models (e.g., the Centers for Medicare & Medicaid Services/CMS Hospital-Acquired Conditions), even though these codes are based on the documentation of licensed providers.During the next Internet broadcast of the venerable Monitor Monday, Dr. James S. Kennedy of CDIMD will propose a strategy that engages payers in how patient conditions or treatments should be defined, diagnosed, and documented, elevating the practice of medicine and confronting denials that are often based on misinterpretations of current clinical literature.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.
Transcribe →Behavioral Health: Avoiding Common Pitfalls
1w ago00:31:48Tap to summarizeBehavioral health services continue to face heightened payer scrutiny. The result: inaccurate documentation, coding, and compliance issues.Panacea Healthcare recently hosted a webinar that focused on three high-risk areas: relative to Behavioral Health–telehealth, psychotherapy with evaluation and management (E&M) services, and the Collaborative Care Model (CoCM).Special guest George Kelly is expected to summarize these issues while outlining the common compliance pitfalls, documentation requirements, coding best practices, and audit risks associated with each service.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Adam Brenman, legislative affairs analyst for Zelis, will report on current healthcare legislation.
Transcribe →Avoiding the Next Claim Denial
2w ago00:29:01Tap to summarizeThere’s a method by which providers can avoid the snare of the latest claim denial strategy to garner attention. Much has been written about the Aetna policy for its “severity inpatient payment” element.Yet almost daily, providers appear to be turning to trusted sources to avoid pitfalls. And that is why the producers of RACmonitor’s Monitor Mondays have invited physician and attorney Dr. John K. Hall to serve as special guest during the next edition of the venerable weekly national podcast.During this remarkable live Internet broadcast, Dr. Hall will unpack the issues that seem to flummox payers, resulting in a variety of actions, ranging from recoupment to reimbursement at lower levels (i.e. “observation” rates).Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, legislative affairs analyst for Zelis, will report on current healthcare legislation.
Transcribe →Seeking Compliance Across the Revenue Cycle
3w ago00:26:42Tap to summarizeMotivated by the notion that healthcare providers are seeking compliance solutions across the revenue cycle, the producers of Monitor Mondays have invited the CEO of Panacea Healthcare Solutions to serve as the special guest during the next upcoming broadcast.Introducing Kevin Chmura. For more than 25 years, Mr. Chmura has been at the forefront of major healthcare vendors as they, in turn, have worked to help their clients achieve success in revenue cycle compliance.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Cate Brantley, legislative affairs analyst for Zelis, will report on current healthcare legislation.
Transcribe →Who will Blink First? 340B Health at Center Stage as Controversy Continues
Jun 1500:29:28Tap to summarizeMaureen Testoni, the stalwart president and CEO of the renowned 340B Health Program, will join the long-running Monitor Mondays todiscuss Eli Lilly’s escalating demands for hospitals to submit in-house claims data as a condition of receiving 340B drug discounts. Who will blink first?Register now to reserve your participation.Broadcast segments will also include these instantly recognizable features:· Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. · The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. · Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.· Legislative Update: Folana Houston, legislative affairs analyst for Zelis, will report on current healthcare legislation.
Transcribe →Recent Lawsuit: Racial Concordance in Healthcare Takes Center Stage
Jun 800:33:37Tap to summarizeAt the heart of a recent lawsuit filed by a physician is whether the medical profession’s understanding and practice of racial concordance is legally defensible.“Find-A-Black-Doctor” has served as a platform for Black, Indigenous, and Persons of Color (BIPOC) to locate providers who can offer them the best holistic treatment.However, some see this as discrimination against white-majority physicians, curtailing their access to potential patients.During my next live edition of Monitor Monday, Dr. Drew Updike, ] review the evidence behind concordance – as it pertains to women’s health, BIPOC patients, and others – to provide you your team with an appreciation of its relevance in modern medicine.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.
Transcribe →AI and Auditing: Major Compliance Risks
Jun 100:34:24Tap to summarizeIt’s that bright new shiny object few seem to manage to resist: artificial intelligence (AI).Here at RACmonitor and Monitor Mondays, we have been reporting on how this disruptive technology has been altering the compliance landscape.And we will continue that reporting. AI is rapidly reshaping healthcare auditing and compliance, and as organizations move toward greater claim visibility and AI-driven review processes, what does that mean for audit exposure, risk, and oversight? Join us during the next live edition of the venerable Monitor Mondays broadcast for an incredible journey, as Pam Warren explores how AI is changing the compliance landscape, and what organizations should be thinking about now. Warren, from AAPC, is the manager of regulatory billing audits for MaineHealth in Maine, the largest healthcare system in Northern New England.Broadcast segments will also include these instantly recognizable features:· Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. · The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. · Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.· Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.
Transcribe →Surge in False Claims Act Violations Triggers New DOJ Initiative
May 1800:26:06Tap to summarizeIntroducing FOCUS (Fraud Oversight through Careful Use of Statistics). The U.S. Department of Justice (DOJ) has launched a new initiative in response to the surge in False Claims Act qui tam filings by data miners.Today, roughly 45 percent of DOJ cases involve FCA data miners. You and your team will learn the inside story of this new initiative along with news of two significant data miner-initiated cases: a $6.73 million settlement against a California vascular physician who billed Medicare for unnecessary stent procedures at 30 times the national average; and a $300,000 settlement against three Illinois skilled nursing facilities that billed Medicare for unnecessary and inflated rehabilitation services.Reporting this dramatic story will be whistleblower attorney and a partner in the New York office of Whistleblower Partners, Hamsa Mahendranathan. Broadcast segments will also include these instantly recognizable features:· Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. · The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. · Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.· Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.
Transcribe →When Algorithms Audit Algorithms
May 1100:28:48Tap to summarizeHealthcare compliance has entered the machine-learning era, and most organizations have not yet noticed. Providers are using artificial intelligence (AI) to generate documentation, surface reimbursable conditions, and tighten coding workflows. Regulators and payers are using AI to detect abnormal patterns, flag statistical outliers, and identify documentation that does not align with expected clinical behavior. Both sides are operating faster than traditional human oversight can follow, according to senior healthcare analyst Frank Cohen, the special guest during the next live edition of the long-running Internet broadcast Monitor Monday, coming your way Monday, May 11 at 10 a.m. EST.Join Cohen as he walks you and your team through a labyrinth of AI obstacles so you can avoid fines, takebacks, and penalties.Broadcast segments will also include these instantly recognizable features:· Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. · The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. · Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.· Legislative Update: Folana Houston, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.
Transcribe →Developing Story: Updating Sepsis Terminology in ICD-10-CM
May 400:29:25Tap to summarizeDocumenting and coding sepsis has challenged virtually everyone in healthcare ever since Sepsis-3 redefined the condition in 2016 as a “life-threatening organ dysfunction due to a dysregulated host response to infection.”Meanwhile, ICD-10-CM still maintains the older Sepsis-2 language of sepsis (SIRS/Systemic Inflammatory Response Syndrome due to infection, without organ dysfunction) and severe sepsis (sepsis that does result in organ dysfunction).During the next live edition of Monitor Monday, Dr. James S. Kennedy will report on efforts currently underway to address the recent Centers for Disease Control and Protection (CDC) proposal to align ICD-10-CM to Sepsis-3/Phoenix terminology, and to introduce new codes for “impending sepsis,” also known as pre-sepsis: a morbid continuum between a localized infection with and without Sepsis-3/Phoenix-defined sepsis .Dr. Kennedy is expected to solicit assistance from Monitor Mondays listeners toward a reasonable solution.Broadcast segments will also include these instantly recognizable features:• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.• Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.
Transcribe →