Monitor Mondays

You need to get paid properly for surgical procedures on the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only (IPO) List, according to Mary Beth Pace, vice president of care management at Trinity Health, and also the special guest during the next live edition of Monitor Mondays.

Pace, in making the statement, was referring to rules and regulations set forth in the Federal Register for Medicare in 2024. She also alleges that some Medicare Advantage (MA) plans are not abiding by some of those rules and regulations. Pace says all MA plans need to abide by the IPO and reimburse correctly.

But does your facility have the processes in place to ensure that you are being paid correctly for surgical procedures on the IPO? Be sure to listen in order to find out.

Other segments during the weekly Internet broadcast will 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.

• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

What’s wrong with this picture?

With more than 10 years of the Centers for Medicare & Medicaid Services (CMS) Two-midnight Rule now behind us, one would presume that most healthcare professionals should know what determines an inpatient status. But some don’t.

That is why RACmonitor has invited renowned physician and attorney Dr. John K. Hall to report on the requirements and risks associated with inpatient order documentation during the next edition of Monitor Mondays.

Other segments during the weekly Internet broadcast will 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.
  
  
• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

A comprehensive new survey featuring responses from more than 1,500 U.S. patients reveals that they are not only frustrated by poor provider support, but also are experiencing tangible health setbacks – especially when waiting to refill prescriptions and being placed on hold while waiting to speak to a caregiver.

Israel Krush, CEO and Co-Founder of Hyro, the healthcare vendor whose company sponsored the survey, is scheduled to be the special guest during the next live edition of the long-running Internet broadcast Monitor Mondays, produced by RACmonitor.

Hyro’s “Voice of the Patient” survey and accompanying report highlight significant gaps between patient needs and the current support available through healthcare delivery channels.

Other segments during the weekly Internet broadcast will 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.

• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

In response to the devastation caused by Hurricane Debby, now Tropical Storm Debby, the Centers for Medicare & Medicaid Services (CMS) has announced additional resources and flexibilities to support the affected states of Florida, Georgia, and South Carolina.

Following President Biden’s emergency declarations and U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra’s Public Health Emergency determination, CMS is working closely with these states to ensure continued access to critical healthcare services.

Importantly, CMS is offering state waivers and other support to help healthcare providers in the impacted regions maintain operations and deliver essential care during this challenging time, according to Timothy Powell, an independent senior healthcare consultant, who also serves as the national correspondent for ICD10monitor and will be the special guest for the next edition of Monitor Mondays.

Other segments during the weekly Internet broadcast will 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.

• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The U.S. Department of Justice (DOJ) has a new whistleblower reward initiative called the DOJ Corporate Whistleblower Awards Pilot Program.

The Program, which seeks to fill gaps left by existing whistleblower reward programs, incentivizes whistleblowers to bring tips to the DOJ about types of healthcare fraud not already covered by the False Claims Act (FCA). According to Monitor Mondays special guest Mary Inman, the new Program raises the stakes for the entire healthcare industry, especially among those who typically ignore or disregard internal reports concerning whistleblowers.

Other segments during the next edition of the weekly Internet broadcast will 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.

• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

The Inpatient Prospective Payment System Final Rule for Acute Care and Long-Term Care hospitals in the 2025 fiscal year (FY) continues to generate interest from providers, payers, hospital administrators, vendors, and consultants. But what are the significant takeaways for stakeholders as they prepare for the government’s fiscal year, which begins Tuesday, Oct. 1, 2024?
Standing by to report the lead story during the next live edition of the long-running Monitor Mondays broadcast will be subject-matter expert Dr. James Kennedy.
Other broadcast segments will 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.

• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Denver-based DaVita Inc. has agreed to pay slightly more than $34 million to resolve allegations that it violated the False Claims Act (FCA).
The U.S. Department of Justice (DOJ) reported in a news release that DaVita paid kickbacks to induce referrals to DaVita Rx, a former subsidiary that provided pharmacy services for dialysis patients, directing the payments to nephrologists and vascular access physicians.
During the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman will report the details on this amazing story, focusing on the provisions of the Anti-Kickback Statute that prohibit anyone to induce referrals of patients or items for services covered by Medicare, Medicaid, and other federally funded programs.
Other broadcast segments will 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.

• Legislative Update: Kate Choe, an undergraduate student at Brown University who is also interning at Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Could the end be near for the administrative law judges of the Centers for Medicare & Medicaid Service (CMS). What about the Office of Medicare Hearings and Appeals (OMHA)? Could these entities be gone from the audit landscape?

Case in point: the Supreme Court (SCOTUS) continues eviscerating executive powers. This time SCOTUS has limited the authority of administrative tribunals and the administrative law judges to adjudicate some cases—this according to a recent SCOTUS decision.

While the actual case relates to administrative hearings at the Securities and Exchange Commission (SEC), the limitations likely transcend that agency.

During the next live edition of Monitor Monday, physician and attorney, Dr John K Hall, will discuss the potential impacts of the decision and what impact it might have on Office of Medicare Hearings and Appeals (OMHA) and the Centers for Medicare & Medicaid Services (CMS) administrative law judges.

Other 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.

• Legislative Update: Cate Brantley, a senior government affairs liaison for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

Have you ever wondered how professional movers carefully pack everything? From expensive china to precious crystal stemware, they seem to have a knack and knowledge for how to prepare.

When it comes to healthcare, how safe is the transition from hospital to home if a patient cannot get the services they need at home when they are ready to transition?

More and more, we are seeing challenges with home health care agencies not being available for our patients who need home care at discharge, according to Mary Beth Pace, vice president of care management at Trinity Health. During the next live edition of the long-running Monitor Mondays live broadcast, acting as special guest, she will unpack all the important steps for ensuring safe transitions.

Other 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.

• Legislative Update: Adam Brenman, a senior government affairs liaison for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

For nearly four decades, a judicial principle known as “Chevron deference” has guided the federal courts as they reviewed litigation associated with federal agencies. Chevron deference allowed legislators to leave statutes somewhat vague, assuming that an agency full of government experts would sort out the details and promulgate effective regulation.

But, according to a recent U.S. Supreme Court (SCOTUS) decision, the principle is fundamentally flawed – in fact, fatally flawed. The decision throws it out in its entirety. This has the potential to upend years of U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) regulation.

Distinguished physician and attorney Dr. John K. Hall will report on the resultant doom and gloom of potential outcomes, and how it may affect providers and payers, during the next live edition of Monitor Mondays.

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.

• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.