Monitor Mondays

Monitor Mondays

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

Episodes

November 30, 2022 3 min

Listen to Mary's Bookclub, where Mary summarizes the products you can find at the MedLearn online bookstore!

In this episode, Mary goes over the Comprehensive Cardiology All Access Pass, and why it is an important product for healthcare professionals. 

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We’ve all watched in awe as the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) began investigating the Medicare Advantage plans. Many were thinking, “it’s about time the payers get some of the heat providers feel.” But there’s something even better, according to most. That’s when the OIG investigates the government.

During the next live edition of Monitor Mondays, physician-attorney Dr. John K. ...

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Most healthcare providers are swimming in shark-infested waters these days, ever-watchful for dorsal fins that signal imminent danger.  

At first there were the Recovery Auditors (RAs), created by the Centers for Medicare & Medicaid Services (CMS), to correct Medicare billing submitted by providers for services rendered to Medicare beneficiaries. And now, nearly two decades later, the RAs have been joined by several other audito...

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November 16, 2022 2 min

Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore!

In today's episode, Mary explains the importance of Ultrasound CoderListen in to find out why this textbook could be a great addition to add to your essential library.

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Along the gulf shores of Mobile Bay in Alabama, at the crack of dawn you might hear shouts of jubilation from early risers there to witness flounder, soft-shell blue crabs, and gulf shrimp beach themselves due to the upward movement of oxygen-deprived bottom waters. The aftermath is a bounty of seafood on the sandy beaches, and hence the local dish known as “jubilee.”

Yet when it comes to local healthcare providers dealing with the ...

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The Medicare Physician Fee Schedule Final Rule for 2023 includes a provision for telehealth services – this following the temporary expansion of telehealth to beneficiaries during the COVID -19 public health emergency (PHE) that began March 1, 2020. Once the temporary PHE waivers terminate, what are the plans the Centers for Medicare & Medicaid Services (CMS) has for covering telehealth services for Medicare beneficiaries?

Join ...

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Healthcare attorney Andrew Wachler is an audit warrior, with war stories that will make you cringe in absolute disbelief.

And during the next live edition of Monitor Mondays, Wachler will tell some of these stories, sharing lessons to learn from his experience defending provider clients. He’ll report how failure to appeal a target, probe and educate (TPE) audit could establish a “pattern or practice of submitting claims fail to meet...

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Rumors, as they tend to sometimes, are spreading fast. Are there significant leadership changes coming within the largest Medicare Advantage (MA) plans for many beneficiaries in the mid-South region of the country?

Spend time with Jennifer Bartlett, longtime systems coordinator at Infirmary Health System in Mobile, Alabama, and it becomes clear that there could be a whole new ballgame, with new players. Are MA plans recalibrating th...

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DRG validation denials by Medicare Advantage (MA) plans have become a widespread and increasing concern for many hospitals.

But these denials may be the result of a misapplication of standard diagnostic criteria by a reviewer. Now, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is turning the DRG validation denials back on MAs. The OIG recently published several diagnosis-validation audits o...

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Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore!

In today's episode, Mary explains the importance of Nuclear Medicine & PET CoderListen in to find out why this textbook could be a great addition to add to your essential library.

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While the pandemic may have shielded healthcare providers from intrusive recoupment audits, the auditing break was but temporary. Starting in August of 2021, UPIC, TPE, RAC and other audits started back up and the contractors had a lot of catching up to do. At the same time, the administrative law judges were under enormous pressure to get the backlog of cases completed by the end of 2022. The result? A paradigm shift in how hearin...

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According to the U.S. Department of Justice, pharmaceutical giant Biogen will pay $900 million to settle a lawsuit that alleged the company gave doctors kickbacks to encourage them prescribe its drugs. The settlement resolves a lawsuit filed and litigated by former Biogen employee Michael Bawduniak against Biogen under the qui tam or whistleblower provisions of the federal False Claims Act. Famed whistleblower Mary Inman will repor...

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Beware of enforcement action by the Centers for Medicare & Medicaid Services (CMS) for noncompliance of the Hospital Transparency Rule which took effect January 2021. The rule requires hospitals to make public—in machine readable files—prices for certain items and services. Failure to comply could result in fines as in the case of two Georgia hospitals. Make no mistake. CMS is laying down the law. Reporting our lead story durin...

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September 21, 2022 1 min

Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore!

In today's episode, Mary explains the importance of CT/MR CoderListen in to find out why this textbook could be a great addition to add to your essential library.

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September 19, 2022 31 min

Provisions in the newly enacted Inflation Reduction Act represent some of the most significant changes to the healthcare system that have taken effect in the past decade. Maureen Testoni, president and CEO of 340B Health, will review some of the new law’s drug pricing elements. They include provisions for Medicare to start negotiating the prices it will pay for certain drugs for the first time in the program’s history. How these dr...

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A national debate is raging across America involving providers and payers. The vexing issue is of medical necessity—and the search for consensus on a definition for this simple yet complicated issue. 

During the next live edition of Monitor Mondays, Tim Brundage, MD will set the table for a robust discussion. Also on the rundown, the growing presence of private equity firms in healthcare. Given that they see healthcare as an attract...

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Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore!

In today's episode, Mary explains the importance of Peripheral & Cardiology CoderListen in to find out why this textbook could be a great addition to add to your essential library.

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The warning was shot across the bow of Medicare Advantage Organizations (MAOs). The U.S. Department of Health and Human Services (HHS) Office of Inspector (OIG), in a report to the Centers for Medicare & Medicaid Services (CMS) raised concerned that MAOs could be denying prior authorizations requests in an attempt to increase profits.

CMS agreed to the report and, on Aug. 3, issued new guidance on the appropriate use of MAO clin...

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The public health emergency caused by Covid-19 compelled the U.S. Department of Health and Human Services to loosen the regulations to fund more telehealth services, and these "temporary" policies may be extended. 

But what many may not know is that the United States has been experimenting with telehealth for 122 years, since the turn of the previous century, according to Edward M. Roche will report the lead story during the...

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August 15, 2022 30 min

Although the “Inflation Reduction Act (H.R. 5376)” is still alive and headed to President Biden’s desk for his signature, there are provisions, deep inside the proposed legislation that will lower health care and prescriptions drug costs and could impact beneficiaries of some government-sponsored health insurance plans.

During the next live edition of Monitor Mondays, physician and attorney Dr John K. Hall will autopsy the bill, dis...

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