Monitor Mondays

Artificial intelligence (AI) is fast becoming a fixture in healthcare revenue cycle management (RCM), where finance leaders are desperate for ways to relieve understaffed departments struggling under unprecedented volumes of third-party audit demands and rising denial rates without sacrificing accuracy or precision.

During the next live edition of Monitor Mondays, the CEO for MDaudit, Ritesh Ramesh, will report on why keeping humans in the loop is the best strategy for preventing negative outcomes.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Juliet Ugarte Hopkins, MD, substituting for Dr. Ronald Hirsch, will be making her 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.

They’re looking for fraudsters, going on the prowl for bad actors, as revealed in the latest semi-annual report to Congress compiled by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). In this latest report, the government watchdog identified more than $2.76 billion in expected recoveries and receivables.

Providing analysis and context for the OIG report released June 3 during the next edition of Monitor Mondays will be James S. Kennedy, MD, a subject matter expert who will review highlights and offer suggestions for remaining compliant.

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.

Most healthcare investigations by the U.S. Department of Justice (DOJ) result in settlements. Many times, the complete details of the settlements in underlying government cases are not fully disclosed. But sometimes, a provider ends up at trial. And when that happens, it often offers insights into what it takes to get hit with hefty fines – and possible prison time, if you lose the case.

During the next live edition of Monitor Mondays, physician and attorney Dr. John K. Hall will review two recent convictions against individual physicians, and offer suggestion for avoiding big payouts and incarceration.

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.

A deep dive into microbiology can reveal an up-close look at the cells that make up organs of the human body – and corresponding cancer treatments that leave no trace of damage.

The science of medicine appears to be moving at the speed of light lately. But will new healthcare technologies be audit-proof? Monitoring these escalating changes and their impact on America’s delivery of healthcare services during the next live edition of Monitor Mondays will be RACmonitor investigative reporter Edward M. Roche.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Clarrisa Barnes, MD, President and CEO for the American College of Physician Advisors, is substituting for Ronald Hirsch to report on her 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.

Two recent settlements to resolve allegations of violating the False Claims Act – both involving the virulent COVID-19 – are the latest in a series of actions that will be reported on during the next edition of Monitor Mondays by famed whistleblower Mary Inman, who also notes that her company, Whistleblower Partners, LLP, is poised to announce another major case pending the unsealing of court documents expected this week.

Among the two cases, one involves the U.S. and California versus ReNew Health Group, LLC and two of the firm’s executives. The settlement alleges that the company knowingly submitted false Medicare Part A claims for nursing home residents. The other settlement involves Atlanta-based Insight Global LLC, which allegedly failed to implement adequate cybersecurity measures to protect personal health information of individuals involved in contact tracing efforts.
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: Folana Houston, assistant general counsel 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 arms race is heating up.

On one side there are healthcare providers, and on the opposing side, an army operated by the auditors. Who will be the winners and losers?

Are you safe? And how do you protect your facility from claim denials and takebacks, especially when auditors are using artificial intelligence (AI)?

RACmonitor investigative reporter Edward M. Roche will return to Monitor Mondays this coming Monday to report on the escalating AI arms race. Roche, who just completed an exclusive three-part series for RACmonitor on AI auditing, will also report on essential steps you and your colleagues can deploy in defense of such audits.

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.

Do you have peer-to-peer (P2P) discussions?
Are they useful? Are they valuable? And how do you know?
Our own physician and attorney, Dr. John K. Hall, will offer his unique take on the value of P2P interactions and how you should measure it during his appearance as Guest Panelist on the next upcoming 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, a senior government affairs liaisons 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.

Like seasoned harbor pilots navigating tugboats through natural and manmade hazards, physician advisors each day face the daunting task of guiding their hospitals through a labyrinth of Medicare rules and regulations.

Reporting on those conditions during the next edition of Monitor Mondays will be the vice chair of the recently concluded national conference of the American College of Physician Advisors, Stephanie Van Zandt. In that role, Dr. Van Zandt had a front-row seat to the history-making conference that concluded Thursday in Coronado, Calif. Dr. Van Zandt is expected to report on the key Medicare policy issues that continue to define the role of physician advisors.

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: Folana Houston, assistant general counsel 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.

Artificial Intelligence (AI) software is now in the “hype phase” of adoption.

It promises to increase the efficiency of medical audits. But also, AI is being touted as being able to handle much more data, examine many more cases, and instantly make decisions regarding medical necessity or inadequate documentation.

The number of audits can be doubled, tripled, quadrupled. Why take samples for review when AI can audit every single claim submitted? Providers can expect a deluge of demands for recoupment, all delivered with exquisite and compelling prose.

But is AI as accurate or as thorough or efficient as promised? During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will review basic defense strategies that providers can deploy against such audits, and look into the future to uncover some of the problems on the horizon.

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 Bart Daniels, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Legislative Update: Cate Brantley, senior government affairs liaisons 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 recent $37 million settlement against Cigna regarding enhancing risk adjustment factor (RAF) scores —along with related litigation by the U.S. Department of Justice (DOJ)— highlight the aggressiveness of the federal government to crack down on entities for non-compliant billing practices.

During the next live edition of Monitor Mondays, Dr. James Kennedy will unpack the challenges entities have with this hot billing compliance issue. Dr. Kennedy will also recommend an approach that attempts to clarify what facilities and physicians can do to mitigate their risks.

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.