At least 1.3 million Medicaid enrollees have been disenrolled as of June 20, according to the Kaiser Family Foudation (KFF) “Unwinding Tracker.” This estimate could be an under-count, KFF admits, due to state recordkeeping details. Yet the major issue looms on the horizon: what will happen to those who have lost their Medicaid benefits? Could a tsuansmi of patients without health insurance soon appear at your hospital?

During the next live edition of Monitor Mondays, Tony DiLuca, principal at Physician and Tactical Healthcare Services, LLC (PATHS) and a member of the Pennsylvania Department of Health and Human Services (HHS) Fee-for-Service Subcommittee, will report on the unwinding process of the enrollment, along with current updates and best practices.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, 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.
  
  
• Legislative Update: Cate Brantley, a legislative analyst for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

“Hospitals may be the most complex organizations in the world,” writes Edward M. Roche, scholar, United Nations consultant, and RACmonitor investigative reporter. “They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals.”

Roche, who will be the featured panelist during the next live edition of Monitor Mondays, believes that hospitals, in their quest for stability, have been nonetheless traumatized by the COVID-19 epidemic and a suffocating regulatory environment. Roche will also report on how many American hospitals now are in the midst of a digital transformation that is leading to an era of “smart hospitals” that will deliver unparalleled integration and improvements in all aspects of healthcare.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, 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.
  
  
• Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

Healthcare organizations often face staffing shortages in their revenue cycle, adding to the pressure of ensuring proper claims processing. The Centers for Medicare & Medicaid Services (CMS), U.S. Department of Justice (DOJ), and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) have increased audits to reduce improper payments, using predictive modeling and artificial-intelligence (AI) tools. Risk-based audits rose by 28 percent and prospective audits by 32 percent in 2022.

To ease the burden on revenue cycle management (RCM) teams, a combination of automation, analytics tools, and denial management software can be used for hybrid audits, reducing denials and increasing reimbursements. During the next live edition of Monitor Mondays, Ritesh Ramesh, CEO for MDaudits, will report on how, by leveraging people and technology, internal audits can be conducted faster, errors caught earlier, and staff can focus more on training and optimizing revenue.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday rounds.
  
  
• The RAC Report: Healthcare attorney Kyla Wonder, 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.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

This week, a disgraced Elizabeth Holmes was seen in media clips walking in the company of two unidentified men. Evidently, Holmes, who was convicted of fraud for her blood-testing start up, Theranos, turned herself in at a minimum-security prison in Texas to begin an 11-year prison term.

All this media coverage raises the question: how easy is it to run afoul of the government regarding a wide range of statutes and regulations?

Moreover, how far do you have to go to actually get to prison? During the next live edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine some recent convictions and sentences to help you assess your risk – keeping in mind that there’s no parole from federal prison.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Bonney Olney, director of Level of Care Service for R1 RCM, will make her Monday rounds, substituting for Dr. Ronald Hirsch.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Cate Brantley, JD, a legislative analyst for Zelis, will report on current healthcare legislation.
  
  

Why the confusion and the apparent uptick in denials by Managed Care Organizations (MCOs) for skilled nursing facility (SNF) transfers?

Returning to report on this vexing topic during the next live edition of Monitor Mondays will be Ben Kartchner, MD, a physician advisor who will join the broadcast to present the final installment in his two-part series being produced by RACmonitor and Monitor Mondays.

Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors, exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with newly gained knowledge from the broadcast, including the actual medical necessity requirements for SNF transfers.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Mary Beth Pace, vice president of Trinity Health, will be making her Monday Rounds, substituting for Dr. Ronald Hirsch.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

Medical necessity denials for skilled nursing facility (SNF) transfers by Managed Care Organizations (MCOs) are increasing at an astonishing rate.

The reason seems to be a lack of understanding of the difference between skilled and non-skilled care. During an exclusive two-part series being produced by RACmonitor and Monitor Mondays, Ben Kartchner, MD will delve into this complex topic that is generating buzz, especially among physician advisors, many of whom appear to be struggling with post-acute care (PAC) and, specifically, SNF services. In fact, Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with newly gained knowledge from the broadcast, including the actual medical necessity requirements for SNF transfers.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, 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 Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Adam Brenman, a legislative analyst for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

Your medical staff office just notified you that a physician has been performing procedures without privileges for the past five years.

No, it doesn’t happen all the time. But what should you do?

Physician and attorney Dr. John K. Hall will walk you through the considerations and help you understand how much revenue might be in jeopardy during the next live edition of Monitor Mondays.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, 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 Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

Hospital utilization and billing are notoriously challenging concepts for providers and case management staff because they frequently boil down to two, often conflicting points of view: what can be done per the rules, regulations, and contracts, and what should be done to provide the most effective care for a patient?  In a world where process standardization is imperative to maintain health system viability, but also where the practice of medicine remains an art, teams need a broad understanding of medical necessity and billing rules.

Join us during the next live edition of Monitor Mondays when Dr. Juliet B. Ugarte Hopkins reports on where you can give and take and how to parse out the varying shades of grey.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, 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 Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs analyst for Zelis, will report on current healthcare legislation.

The beleaguered False Claims Act, which traces its origins to the Civil War, came before the Supreme Court this past Tuesday, when the Court heard oral arguments in a consequential and closely watched case involving one of the Government’s most effective tools for fighting healthcare fraud. 

Specifically, the issue is whether and when a defendant’s contemporaneous subjective understanding or beliefs about the lawfulness of its conduct are relevant to whether it knowingly violated the Act. This case involves accusations that supermarket pharmacies Safeway and SuperValu overcharged Medicare and Medicaid for generic drugs by misrepresenting the usual and customary prices they charged for the drugs.

During the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner at the law offices of Constantine Cannon, will provide background and context on the case that the Court is expected to issue a ruling for in June, at the end of its term. 

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, 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 Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Adam Brenman, legislative analyst for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.

Recent highly publicized advances in artificial intelligence forecast the elimination of at least 30 percent of the healthcare workforce (probably more), including all generalist physicians. The astonishing scalability of information technology suggests that one to three data centers will be able to deliver medical advisory services to the entire population of the United States, according to Edward M. Roche, who will be reporting our lead story during the next live edition of Monitor Mondays.

Roche is expected to report that as a country, America will see the debilitating cost of much healthcare being delivered today reduced to pennies and for all practical purposes delivered free of charge. But, cautions, Roche, such a game-changer will not be put in place without much resistance. So, who will be the winners and the losers in this new era of AI-driven healthcare? Register now to listen Monday.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. James Kennedy, President of CDIMD, will be making his Monday Rounds, substituting for Dr. Ronald Hirsch.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.
  
  
• The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.