Are recent denials by Medicare Advantage plans egregious examples of the insurance companies’ overreach? Or is there simply greater awareness of an age-old problem?

Sorting out this ongoing issue during this edition of Monitor Mondays will be R. Phillip Baker, MD, medical director of case management at Self Regional Healthcare in Greenwood, N.C. and a member of the board of directors of the American College of Physician Advisors. Dr. Baker has been working with the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Group for the last two years, and has gotten them to put in writing statements noting that these plans have to follow original Medicare regulations for non-contracted facilities. 

The broadcast rundown also will include:

• Medicare Advantage Report: A central concern about the capitated payment model used by Medicare Advantage Organizations (MAOs) is the financial incentive for them to inappropriately deny access to services and reimbursements for services rendered in order to increase their profits, according to Knicole Emanuel, partner at the Potomac Law Group, who reports on this developing story.
  
  
• Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron answers listeners’ questions from previous broadcasts on subjects that could be potentially troublesome.
  
  
• “Hello, Are You There?” Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, reports on problems now being created because a Quality Integrity Contractor (QIC) failed to respond to his appeal issues.
  
  
• When Minutes Count: Phones lit up and social media seemed to explode last week when CMS announced it might not allow minutes to count when therapy services are provided by students. The exclusive story was reported on RACmonitor by nationally renowned inpatient rehabilitation facility (IRF) expert Angela Phillips, the president and CEO of Image and Associates. Phillips reports on the details behind the news that is rocking IRF providers’ worlds.
  
  
• Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, returns to report on all the latest hot topics.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.