Monitor Mondays

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 risk within your organization, according to senior healthcare analyst Frank Cohen. Cohen, long associated with Monitor Mondays, will return to the famed weekly Internet broadcast this coming Monday to begin a series on CERT: the Good, the Bad, and the Ugly.

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. 

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

•Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on current healthcare legislation.

•Lead Story: Senior healthcare analyst Frank Cohen will return to Monitor Mondays to begin a new series on the CMS program CERT.

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 outcome will be submitted to the 77th WHO Assembly in May.

RACmonitor investigative Edward M. Roche will report the latest on this possible international compliance issue during the next live edition of Monitor Monday. 

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. 

·  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, state legislative analyst for Zelis, will report on current healthcare legislation.

· Lead Story: RACmonitor investigative reporter Ed Roche will report on potential international compliance rules in the event of another global pandemic.

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 the smartest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – except here and in RACmonitor.

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. 

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

· Home Care and Hospice: William Dombi, president and CEO for the National Association for Home Care and Hospice, will report on the latest news concerning Medicare home health and hospice but also Medicaid’s Home & community-based services (HCBS).

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

·Docs and Regs: Monitor Mondays’ own physician and attorney, Dr. John K. Hall, will report on the impact of artificial intelligence on healthcare.

· Tech Report: RACmonitor investigative reporter Edward M. Roche will report on the latest technology trends impacting America’s healthcare delivery system.

· Lead Story: Frank Cohen, founder of the Frank Cohen Group will report on his recent study about how major changes to the 2021 evaluation and management (E&M) services is impacting 2024 E&M coding and compliance.

“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 to whom he has bestowed the esteemed honor during the next live edition of Monitor Mondays. So far, 15 distinguished individuals have been named “Hirsch’s Heroes.” This year, the loquatious Hirsch will only say for now that the 2023 heroes will be a physician, an attorney, and two revenue cycle professionals.

Other broadcast segments will include these instantly recognizable features:

· The RAC Report: Healthcare attorney Knicole Emanuel 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, state leglistative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

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, and smaller. Roche, who recently introduced to Monitor Mondays listeners the concept of “smart hospitals,” will also take a stab at answering a key question: just how smart are they?

Other broadcast segments will include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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 leglistative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

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 outcomes for both providers and payers.

MDaudit CEO Ritesh Ramesh will appear as the special guest on Monitor Mondays to discuss the latest findings from the annual survey and how AI may impact healthcare revenue, including external payer audits and the detection of compliance and payment risks.

Other broadcast segments will include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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: Adam Brenman, federal analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

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 year.

Providing a roundup of those settlements and judgments during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, a popular and respected correspondent.

Of note, more than $1.7 billion of that 2 billion were matters pertaining to the healthcare industry.

What can you do to protect yourself and your facility from the possibility of violating the False Claims Act? Listen to the next live edition of Monitor Mondays to find out.

Other broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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, state legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

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 and long-running Internet broadcast Monitor Mondays, physician and attorney Dr. John K. Hall will summarize the current state of the Two-Midnight Rule and offer insights of its use into the next decade.

Other broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The Whistleblower Report: Famed whistleblower attorney Mary Inman, partner in the law offices of Constantine Cannon, will report on the latest news concerning whistleblowers.

• The RAC Report: Healthcare attorney Knicole Emanuel 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 analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

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 edition of Monitor Mondays, senior healthcare executive Dennis Jones will report on new regulatory initiatives, individual hospital actions, and one sweeping policy by a state hospital association – all aimed at making hospitals safer places to work.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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 Brandley, state legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

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 to listen to the next edition of Monitor Mondays, when Maureen Testoni, president and CEO of 340B Health, will report on some of the latest Washington developments on these issues, including how they might affect the safety-net hospitals that deliver many of these drugs to patients.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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: Adam Brenman, federal legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.