Monitor Mondays

The public health emergency caused by Covid-19 compelled the U.S. Department of Health and Human Services to loosen the regulations to fund more telehealth services, and these "temporary" policies may be extended. 

But what many may not know is that the United States has been experimenting with telehealth for 122 years, since the turn of the previous century, according to Edward M. Roche will report the lead story during the next live edition of Monitor Mondays. Roche, the Monitor Mondays investigative reporter, will review some of this history, and highlight the emerging challenges of future technologies and the continued peril of fraud and abuse. 

Other segments will include these instantly recognizable broadcast segments:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, 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.
  
  
• SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of healthcare regulations and the SDoH.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. 
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.
   
   

Although the “Inflation Reduction Act (H.R. 5376)” is still alive and headed to President Biden’s desk for his signature, there are provisions, deep inside the proposed legislation that will lower health care and prescriptions drug costs and could impact beneficiaries of some government-sponsored health insurance plans.

During the next live edition of Monitor Mondays, physician and attorney Dr John K. Hall will autopsy the bill, dissecting the legislation to uncover some of the relevant provisions while adding fine points and adds necessary context to this important legislation.

Other segments will include these instantly recognizable broadcast segments:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, 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.
  
  
• SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of healthcare regulations and the SDoH.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

Without admitting guilt, a Florida health system entered into a $20 million settlement under the False Claims Act with the U.S. Department of Justice (DOJ) to resolve allegations that it made donations to increase Medicaid contributions. The whistleblower filed the suit alleging that the system made improper cash donations to a local charity in a scheme to increase the system’s Medicaid funding. At a time when the False Claims Act is under scrutiny, this story—to be reported by famed whistleblower attorney Mary Inman—is relevant and consequential. What lessons can be learned from this not-to-charitable scheme? Listen and learn when Inman, a partner in law office of Constantine Cannon, joins the next live edition of Monitor Mondays.

Other segments will include these instantly recognizable broadcast segments:

•  The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, 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.
  
  
• SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of healthcare regulations and the SDoH.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. 
  
  
• Legislative Update: Folana Houston, assistant general counsel for Zelis, who will be substituting for Matthew Albright, will report on current healthcare legislation.
   
   

Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore!

In today's episode, Mary explains the importance of Essentials of Interventional Radiology Coding.  Listen in to find out why this textbook could be a great addition to add to your essential library.

Like unwanted mushrooms bursting forth from your lawn, the Zone Program Integrity Contractors (ZPICs) appear to be on steroids. Their audits are aggressive disruptors in the vast auditing landscape in which providers continue to provide care and bill for the services they provide. In fact, the recent uptick in their audit activities is in the Medicaid arena. UPICs— the Centers for Medicare & Medicaid Services (CMS) contractors tasked with integrating program integrity functions for audits and investigations across both Medicare and Medicaid—are now coordinating and performing more Medicaid audits.

During the next live edition of Monitor Mondays, prominent healthcare attorney Andrew Wachler, the managing partner of Wachler and Associates, will be reporting on the ZPIC audits he is encountering while offering steps providers and suppliers can take to protect their reimbursement from recoupment.

Other segments will include these instantly recognizable broadcast segments:

• Post Payment Audits: Kevin Lasser, CEO of Rev Keep, will report on the post payment audits.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, 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.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

The recent decision by the Supreme Court to invoke the major questions doctrine to nullify an agency regulation in the case of West Virginia versus the Environmental Protection Agency seems to indicate the court’s trend toward increasingly strict interpretation of statutes. The possibility that new, or even well-established, regulations may be overturned means that healthcare regulation could change drastically on extremely short time scales with no direct input from stakeholders. During the next live edition of Monitor Mondays, physician and attorney Dr. John K. Hall explains the major questions doctrine and its potential impact on healthcare.

Other segments will include these instantly recognizable broadcast segments:

• The RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will report the latest news about auditors.
  
  
• SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of healthcare regulations and the SDoH.
  
  
• Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

Are commercial payers too big to fail? Do they operate with the sense of infallibility? Case in point: UnitedHealthcare Group, which according to its earnings report, posted $4.1 billion in profits in the fourth quarter of 2021. Is the playing field level between payers and providers?  For example, during the review of rejected claims does UnitedHealthcare or any private company such as this have advantages over a healthcare provider compared to what it would be if they were using the regular administrative law judge process?  During the next live edition of Monitor Mondays RACmonitor investigative reporter Edward M. Roche returns to the broadcast to discuss the rights of providers in the two different appeals processes.

Other segments will include these instantly recognizable broadcast segments:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, 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.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
  
  
• Legislative Update: Cate Brantley, Legislative Analyst for Zelis, will report on current healthcare legislation.

Listen to Mary's Bookclub, where Mary summarizes the books you can find at the MedLearn online bookstore!

In today's episode, Mary explains the importance of Cardiac Rhythm Management Coder.  Listen in to find out why this textbook could be a great edition to add to your essential library.

“Good enough for government work,” was once the saying among cynical factory workers. And yet today in healthcare, precision in Medicare statistical analysis really matters. If overpayments are found, then the extrapolation recoupment number will go up; if underpayments are found, the extrapolation will go down.

Listen and learn during the next live edition of Monitor Mondays when RACmonitor investigative attorney Edward M. Roche will report that his team routinely finds Medicare auditors handing in extrapolations that can be plus or minus 10, 15, 20, 30 percent –  or even worse.

“That is somewhere between 25 and 85 percent,” wrote Roche recently in RACmonitor. “But that seems to be good enough for government work.”

Precision in Medicare auditing is a prerequisite. But, sadly—as you’ll learn from Roche—that’s not always the case.

Other segments will include these instantly recognizable broadcast segments:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, 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.
   
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, will report on current healthcare legislation.

Medicare Advantage Audits, Establishing Medical Necessity to Ensure Payments, and the Two-Midnight Rule are three outstanding RACmonitor webcast topics discussed by Dr. John Zelem and Chuck Buck in this current episode of Front and Center.