Monitor Mondays

So far in October, the U.S. Department of Justice (DOJ) has been very busy, securing settlements, pleas, and convictions ranging in value from $25 to $350 million.

And just this month, DOJ announcements have featured settlements related to Anti-Kickback and Stark violations, as well as convictions in genetic testing schemes and guilty pleas for fraud involving unnecessary testing.

During the next live edition of Monitor Mondays, RACmonitor’s own physician and attorney, Dr. John K. Hall, will break down some of these recent reports to give you additional insights and help you understand your own risk.

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: Folana Houston, assistant general counsel for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Coinciding with National Breast Cancer Awareness Month (October), RACmonitor investigative reporter Edward M. Roche recently went to the laboratories of Memorial Sloan Kettering to investigate one of the most exciting scientific developments of the decade.

Roche, who was among the first to introduce the healthcare compliance world to algorithms, artificial intelligence (AI), and “smart” hospitals, said that the molecular biological approach to cancer treatment represents a true scientific breakthrough. He also recounted the three standard treatment stages in America’s efforts to combat breast cancer: surgery, radiation, and chemotherapy. Each of these treatments, according to Roche, can have substantial and sometimes devastating side effects. Now, developments in molecular biology carry the potential to sweep away these approaches and leave patients healthy with a bare minimum of discomfort. But the question remains: when all is said and done, will America’s healthcare insurance companies reimburse providers for these services?

Roche will outline these issues as the featured guest during the next live edition of Monitor Mondays.

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.

The Centers for Medicare & Medicaid Services (CMS) is on record saying that Medicare Advantage (MA) payers must follow the Two-Midnight Rule as of Jan. 1, 2024. Yet, it has been reported by multiple hospitals that their MA plans have said their lawyers tell them that they do not have to follow the CMS directions on the Rule relative to inpatient status, claiming their contracts govern their relationships and coverage issues with hospitals.

During the next live edition of Monitor Mondays, Dennis Jones, senior director of revenue cycle (a single business office) for Jefferson Health, will report on the arguments that seem to be iginiting a firestorm on the Internet.

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: Cate Brantley, state legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

It’s little wonder that we will be reporting on artificial intelligence (AI)during the next live edition of Monitor Mondays. We were among the first to report on algorithms in claims auditing.

But now, with so much attention being paid by the general news media to AI, its role in healthcare is gaining even greater attention and traction. So, during next live edition of our weekly Internet radio broadcast, we will take a deep dive into the role of AI and its use in auditing medical claims for accuracy and compliance when Blake Wylie, chief technical officer for Clarity Ventures Group, joins the broadcast.

By utilizing machine learning algorithms, auditors can sift through vast amounts of data to identify discrepancies and errors, thereby enhancing the overall reliability and efficiency of the medical billing process.

Broadcast segments will 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 will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney Geoffrey Koslig, associated with law offices of Fredrikson & Byron, will substitute for David Glaser, to share his perspective on business issues that might appear (and in many cases, actually are) quite risky.
• Special Report: Govind Goyal, president of financial services for Panacea Healthcare Solutions, will report on the latest news about the beleaguered Hospital Price Transparency rule.
  
  
• Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.
  
  
• Lead Story: RACmonitor investigative reporter Edward M. Roche will report the lead story on the performance scorecard for Medicare.

The United States spends more money on healthcare than any other country in the world. In 2021, U.S. healthcare spending reached $4.3 trillion.

Medicare, which insures seniors, is America’s largest national health program, and therefore, it can and should be compared to its counterpart in other countries. So, how does the United States stack up?

How do outcomes in the United States compare for patients, and what kind of comparisons can we make from the point of view of the healthcare provider? Do doctors have it better in the United States, or in other places? What lessons can we learn? Where are the most urgent areas that need reform?

During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will examine U.S. healthcare in comparison with that of other countries, focusing on a number of dimensions, including cost, quality, outcomes, and ease of use.

Broadcast segments will 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 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.
  
  
• Lead Story: RACmonitor investigative reporter Edward M. Roche will report the lead story on the performance scorecard for Medicare.

The fall season is just about here. Colorful autumn leaves will be becoming ubiquitous, like claims denials and audits. And in this season, now is the time to “git ‘er done.”

And Monitor Mondays is the place to do it.

In preparation, following the long Labor Day weekend, RACmonitor producers of Monitor Mondays have enlisted the services of some of the most trusted and respected names in regulatory compliance and claims auditing. And joining this panel of experts in the long-running Internet broadcast will be a new voice added to the lineup: Angela Jordan, currently executive vice president of Calm Waters AI, Inc., specialists in evaluation and management (E&M) leveling services.

Broadcast segments will 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 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 the latest legislative actions that will impact the healthcare regulatory setting.
  
  
• E&M Update: Angela Jordan, executive vice president for Calm Waters AI, Inc., will report on the latest twists and turns associated with the omnipresent E&M services impacting physicians and physician groups.

First there was COVID-19, which seemed to have torn a gaping hole in our nation’s patchwork quilt of care facilities. Add to this the rising costs of everything that touches healthcare, and now the growing list of Chapter 11 bankruptcies rippling through nursing homes and other facilities that provide care for America’s seniors.

But will the tentacles of this lengthening financial crisis reach down and strike at other similar facilities? Reporting our lead story during the next live edition or Monitor Mondays will be William Dombi, president and CEO for the National Association for Home Care and Hospice.

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 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.

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 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.

Information technology has revolutionized many industries, including healthcare. “Smart” hospitals promise vast increases in productivity, and are being designed as integrated IT platforms linking together technology, patients, and providers in a complex web of interaction.

But are the promised advantages of smart hospitals tangible, or are there a number of factors that may inhibit providers from obtaining the benefits that are promised? And how are things really measured? Edward M. Roche will discuss this high-growth area of expenditures, and go over both the accelerators and inhibitors of this transformation in 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 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,  legislative analyst for Zelis, will report on current healthcare legislation.

The Centers for Medicare & Medicaid Services (CMS) FY2024 Inpatient Prospective Payment System (IPPS) Final Rule, posted on Aug. 1, reveals changes to the MS-DRG, CMS Hospital Acquired Conditions, and CMS Inpatient Quality Reporting Program affecting inpatient revenue cycles, quality reporting, and reputations essential to hospital operations. There are plenty of audit hazards. And that’s why RACmonitor invited James S. Kennedy, MD, a nationally recognized clinical coding authority, to be our expert tour guide during the next live edition of Monitor Mondays to identify potential risks and opportunities effective on October 1, 2023.  

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 Cara Ludwig, substituting for 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, a legislative analyst for Zelis, will report on current healthcare legislation.