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

Episodes

February 26, 2024 27 mins

What happens if the Supreme Court of the United States (SCOTUS) dismantles decades of government agency discretion? Recent cases at SCOTUS indicate that this could happen. But what would be the consequences?

During the next live edition of the long-running Internet radio broadcast Monitor Mondays, RACmonitor’s own physician and attorney Dr. John K Hall will consider the ramifications of the demise of the so-called “Chevron Deference...

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The implementation of generative artificial intelligence (AI) in the Electronic Health Record (EHR) is one of several hot-button issues to be explored during the next live edition of the Monitor Mondays, the long-running Internet broadcast produced by RACmonitor.

Other high-level considerations to be reported include leveraging AI in regulatory compliance, creating physician notes from doctor-patient conversations, and how AI could ...

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The Merit-based Incentive Payment System (MIPS) uses a composite performance score to determine if eligible physicians will receive a payment bonus, a payment penalty, or no payment adjustments. So, what’s the score for your physicians? Do they know?

During the next live edition of the long-running Monitor Mondays, Leigh Poland, vice president of coding services for AGS Health, will report on why it’s essential for all eligible clin...

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February 5, 2024 30 mins

Auditors use the Comprehensive Error Rate Testing (CERT) study from the Centers for Medicare & Medicaid Services (CMS) as a way to target individual providers for potential recoupment. For example, if you get paid millions of dollars for some procedure codes or DRGs that have high error rates, it increases the likelihood that those specific codes and/or DRGs will be audited. Why? Because, statistically speaking, whatever the er...

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What’s important to know about the Comprehensive Error Rate Testing (CERT) program from the Centers for Medicare & Medicaid Services (CMS) is that auditors rely upon the results to target specific providers for recoupment audits.

The more you know about CERT and the study results, the better position you will be in when it comes to understanding both the general risk of an audit and the specific areas that might be at ...

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Will the World Health Organization (WHO) be given the power to impose restrictive pandemic measures on countries, including the United States? Will it be legally binding? What are the challenges and opportunities for healthcare providers in the United States, and how will this be enforced?

The member states of the WHO have been working on a plan of action when faced with the next pandemic. Negotiations are underway now, and their ou...

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January 8, 2024 55 mins

No more eggnog. Toss the champagne bottles. The good times are over, and now it’s back to business. But not business as usual. 

As the rest of the nation’s healthcare professionals clocked in for overtime, claims auditors were scrutinizing medical records, looking for the slightest inconsistency upon which to pounce. Now, nearly four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of ...

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December 4, 2023 29 mins

“He’s making a list, checking it twice…”

With a nod to the legendary Tin Pan Alley composer Haven Gillespie, who penned the lyrics to the iconic holiday song, senior healthcare consultant Ronald Hirsch, MD has been making his own list of healthcare professionals all year, paying close attention to their deeds in the field of healthcare.

Calling them “Hirsch’s Heroes,” an annual tradition that began in 2015, Hirsch will reveal those t...

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RACmonitor investigative reporter Edward M. Roche, an intrepid regular monitor of America’s healthcare system, will return to Monitor Mondays for its next upcoming edition to report on how and why America’s healthcare system has tied itself into a Gordian Knot of complexity: interwoven strands of conflicting rules and regulations, different payments for the same services, and a cumbersome patchwork quilt of facilities, big, small, ...

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The annual 2023 MDaudit Benchmark Report has been published, and it is relevatory in its analysis of articial intelligence (AI) and its impact on payment and revenue integrity. According to the report, the primary topic of discussion for the next live edition of the long-running Monitor Mondays Internet broadcast, the implications of AI are immense when predicting its application to audit workflows – which is expected to impact out...

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To quote the titular lyrics of the song popularized by Frank Sinatra for his very first No. 1 hit, “it was a very good year.”

The U.S. Department of Justice (DOJ) announced that more than $2 billion in False Claims Act settlements and judgments were reported in the 2023 fiscal year.

According to the DOJ, government and whistleblowers were “party to 351 settlements and judgments,” the second-highest number ever recorded in a single ye...

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The Two-Midnight Rule was first announced 10 years ago, October 2013, by the Centers for Medicare & Medicaid Services (CMS). Even today, though, the Rule remains an ongoing source of confusion for physicians as well as revenue cycle and finance experts.

However, it also will take on new importance, as CMS promises that Medicare Advantage (MA) plans will begin to follow the Rule in 2024.

During the next live edition of the popular...

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October 30, 2023 26 mins

Violence in America’s hospitals is an issue that is squarely on the minds of hospital administrators and staff. And the violence seen in our society has increasingly encroached into the medical workplace. This violence can be verbal, it can be physical, it can be disturbing, and it can be deadly. The escalation and prevalence of violence in hospitals has had a major impact on employees, patients, and families.

During the next live e...

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Congress and the Biden Administration continue to take a keen interest in issues related to prescription drug access and pricing. There is evidence of recent movement on Capitol Hill toward legislation aimed at addressing drug shortages affecting the healthcare system.

The government also is implementing a plan Congress approved last year to lower the prices Medicare will pay for certain drugs. For an exclusive update, register now ...

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So far in October, the U.S. Department of Justice (DOJ) has been very busy, securing settlements, pleas, and convictions ranging in value from $25 to $350 million.

And just this month, DOJ announcements have featured settlements related to Anti-Kickback and Stark violations, as well as convictions in genetic testing schemes and guilty pleas for fraud involving unnecessary testing.

During the next live edition of M...

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Coinciding with National Breast Cancer Awareness Month (October), RACmonitor investigative reporter Edward M. Roche recently went to the laboratories of Memorial Sloan Kettering to investigate one of the most exciting scientific developments of the decade.

Roche, who was among the first to introduce the healthcare compliance world to algorithms, artificial intelligence (AI), and “smart” hospitals, said that the molecular biological ...

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The Centers for Medicare & Medicaid Services (CMS) is on record saying that Medicare Advantage (MA) payers must follow the Two-Midnight Rule as of Jan. 1, 2024. Yet, it has been reported by multiple hospitals that their MA plans have said their lawyers tell them that they do not have to follow the CMS directions on the Rule relative to inpatient status, claiming their contracts govern their relationships and coverage issues wit...

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It’s little wonder that we will be reporting on artificial intelligence (AI)during the next live edition of Monitor Mondays. We were among the first to report on algorithms in claims auditing.

But now, with so much attention being paid by the general news media to AI, its role in healthcare is gaining even greater attention and traction. So, during next live edition of our weekly Internet radio broadcast, we will take a deep dive in...

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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 c...

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September 11, 2023 29 mins

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 ...

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