Monitor Mondays

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 Coding Essentials for Laboratories.  Listen in to find out why this textbook could be a great edition to add to your essential library.

Stranger than fiction are the reports coming from providers complaining of inconsistent and often contradictory reasons given for claim denials, leading to recoupment and the possibility of Medicare revoking privileges of participation in federal health programs – and this at a time of shrinking margins, rising inflation, budget cuts, and staff shortages. Little wonder that America’s hospitals, health systems, and physician practices are feeling the pain.

However, during the next special news edition of Monitor Mondays, you will not only hear field reports from our distinguished and highly respected panelists, but also gain the benefit of practical guidance in traversing the treacherous audit terrain.

And, as a special added feature, Monitor Mondays will conduct an exclusive roundtable on the contentious and controversial 340B drug discount program. Substituting for the program’s executive producer and program host, Chuck Buck, will be Dr. John K. Hall.

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.
  
  
• 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, 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 affairs analyst for Zelis, will report on current healthcare legislation. Brantley will be substituting for Matthew Albright.

Denials by payors for hospital claims continue to mount. Hospitals should take every opportunity to have a denial overturned – and an oft-neglected method is with a peer-to-peer call for a concurrent denial. A physician advisor can dedicate time and resources to accomplish it, but what do you do when the payor insists on only speaking with the attending physician?

Since this is a recurring issue with providers and auditors, Monitor Mondays has asked Dr. Chris Shearer to report on this untenable issue – and to offer advice to other providers.

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.
  
  
• 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, 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.

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 Coding Essentials for Infusion & Injection Therapy Services.  Listen in to find out why this textbook could be a great edition to add to your essential library.

Nearly $3 billion in expected recoveries have surfaced in the spring 2022 Semiannual Report to Congress by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). As reported by RACmonitor’s Mark Spivey, the OIG report also provides an overview of the watchdog’s activities from Oct. 1, 2021 through March 31, 2022. 

During the next live edition of Monitor Mondays, providing comment and context to the report, which was published Monday, June 6, will be prominent healthcare attorney Andrew “Drew” Wachler, a longtime OIG observer and the managing partner at Wachler and Associates. 

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. 
  
  
•  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, 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 2022 audit landscape is rife with pitfalls and quicksand, trapping unsuspecting hospitals, health systems, and physician practices into a financial quasi-death spiral.

And now, there’s another major disruptor: Condition Code 44, which continues to confound providers and revenue cycle professionals. Even though the Recovery Audit Contractors (RACs) have been held at bay, there are new audits targeting the proverbial low-hanging fruit, ripe for the picking. Complicating an already dismal radar screen is the return of the Inpatient-only List, bringing enormous confusion and creating the perfect setup for more audits.

Following news updates from a cadre of venerable Monitor Mondays panelists, a grouping of experts will regather around the virtual roundtable during the next edition of the live Internet broadcast, where, led by Dr. John K. Hall, attorney and physician, they will offer advice, answer your questions in real time, and forecast upcoming audits.

Preceding the roundtable, “Tales from the Audit Trail,” will be the following 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.
  
  
• 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, 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.
  
  
• Roundtable Moderator: John K. Hall, MD, will facilitate the roundtable discussion focused on Condition Code 44.

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 Coding Essentials for Respiratory Therapy/ Pulmonary Function.  Listen in to find out why this textbook could be a great edition to add to your essential library.

The 2 MN Rule has been with us for several years but there still is confusion about what qualifies as inpatient.

Condition Code 44 has been the corrective approach to inpatient status errors despite CMS’ warning that Condition Code 44 should not be used as a substitution for inadequate utilization management processes. Condition Code 44 can serve as a reflection that the utilization process is being monitored and claims are billed compliantly. Dr. John Zelem will review the crucial four requirements for Condition Code 44 compliance.

Other segments will include the following:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs).
  
  
• 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, 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 analysis for Zelis, will be substituting for Matthew Albright. Brantley will report on current healthcare legislation.

Johnson & Johnson, along with Gilead, are among the most recent pharmacy giants that have joined the list of others that are imposing restrictions on 340B drug price discounts to 340B hospitals. The latest information comes from a recent study conducted between December 2021 and March 2022 that reveals 16 other major pharmacies are flaunting the law – and their actions have doubled.

Reporting the lead story during the next live edition of Monitor Mondays will be Maureen Testoni, president and CEO of 340B Health. Testoni, a popular guest, is expected to report that consequently, the damage will continue to grow – until these pharmaceutical manufacturers are forced to restore the discounts and obey the law.

Other segments to be featured during the broadcast will include the following:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs).
  
  
• 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, 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.

2010 does not seem that long ago. It’s hard to believe we’re at Monitor Mondays broadcast No. 500 since then.

But then again, let’s look at all we’ve seen change. Medicare started out with a one-midnight expectation for inpatient reimbursement. Then the Recovery Audit Contractors (RACs) moved in, showed us all the errors of our ways, and demonstrated that unrestrained denials could overwhelm the appeal system.

Then we got the two-midnight rule, which, oddly enough, seemed to make sense. It carved off a bunch of inpatient stays, but also curtailed denials. Then we saw the phase out of the inpatient-only list. But wait – the Centers for Medicare & Medicaid Services (CMS) reversed course and decided not only to keep the inpatient-only list, but to add stuff back on to it. 

The one constant since 2010, via more than 500 live broadcasts,has been Monitor Mondays, bringing cutting-edge analysis of regulatory changes and providing reliable information for you to meet payor challenges. We’re looking forward to another 500 episodes. And we’re sure the payors will help us with new material.

Additional segments to be included in this landmark broadcast will include the following:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs).
• Monday Focus: Mary Beth Pace, vice president of care management at Trinity Health, will report on outpatient status for those who have undergone surgery.
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
• Monday Rounds: Dr. Andrew Markiewitz, substituting for Dr. Ronald Hirsch, will make his Monday Rounds.
• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on current healthcare legislation.