Monitor Mondays

It has been more than 10 years since Richard Bagnall filed suit against Kathleen Sebelius, in her role as Secretary of the U.S. Department of Health and Human Services (HHS). Since then, the case has been recaptioned several times, and bounced back and forth between the U.S. District Court for Connecticut and the U.S. Court of Appeals for the Second Circuit. But the class-action suit, now known as Barrows v. Becerra, finally now has a decision from the latter.

RACmonitor’s physician and attorney, John K. Hall, will return to the Monitor Mondays broadcast to report on whether the decision is reason for you to get excited – or just shrug.

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

• 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: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on current healthcare legislation.
• 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.

In a terse, matter-of-fact announcement, the U.S. Department of Health and Human Services (HHS) is promising “significant enforcement” if providers have not complied with rules surrounding the Provider Relief Fund (PRF).

This time, HHS is focusing on whether hospitals that received PRF payments complied with the surprise billing provisions of the PRF terms and conditions. Providing an early defense warning of the imminent government audits during the next edition of Monitor Mondays will be healthcare attorney Andrew Wachler, managing partner of Wachler and Associates, who is expected to warn providers that these audits are likely just the beginning.

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

•  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: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
•  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. 

Medicare Advantage audits and spinal procedures relative to the Inpatient-Only List are two outstanding RACmonitor webcast topics discussed by Dr. John Zelem and Chuck Buck in this current episode of Front and Center.

These complimentary special edition podcast from RACmonitor features Chuck Buck and John Zelem, MD as they review on-demand webcasts as well as preview upcoming webcasts. Dr. Zelem offers a unique physician perspective as he explains to listeners key learning objectives from these educational webcasts.

Visit RACmonitor.com to view more informational webcasts

A growing number of drug manufacturers are imposing unlawful limits on 340B discounts, according to a newly released report by 340B Health. Currently, up to 13 such companies “just say no” to discounts for prescription drugs sold to safety-net hospitals and dispensed through community pharmacies.

During the next live edition of Monitor Mondays, reporting on the findings of this new report released late last month will be Maureen Testoni, president and CEO for 340B Health. Testoni is expected to report on how these major manufacturers are having a deleterious impact on 340B hospitals, while at the same time possibly harming patients.

The 340B program, established in 1992, allows these 340B providers to purchase outpatient drugs at a reduced cost and to use those savings to be invested in patient care.

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

• 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.
• Monday Focus: Mary Beth Pace, vice president of care management for Trinity Health, will report on the alarming staffing crisis among case management professionals in America’s hospitals.
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
• 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.

For many third-party Medicare auditors, the only rules they follow are their own, substituting personal preference for regulatory realities – and all in the name of claim denials. Every day in nearly every American hospital, health system, or physician practice, some dedicated healthcare professional asks, “how could they do this to us?”

There is a rightful place for Medicare auditing. But too often, in too many instances, legitimate auditing takes a backseat to the arbitrary denial of claims. This week, during another live edition of Monitor Mondays, the most trusted subject-matter experts in healthcare regulation will come together to discuss the latest examples of auditing gone awry. And highlighting the role of the physician advisor, who often is asked to interpret regulations, will be Dr. Elizabeth Quinn, the National Physician Advisor Conference chair.

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

• 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.
• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
• 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.

The story first broke here on RACmonitor, when investigative reporter Edward M. Roche wrote about a case of double-dipping: the act of an auditor sampling and extrapolating against the same set of claims.

As Roche explained in his exclusive RACmonitor article, the practice is like receiving two traffic tickets for a single instance of running a red light. The practice doubles the amount of recoupment demanded. Providers pay twice.

During the next live edition of Monitor Mondays, Roche will report on this unseemly practice in general, but will also provide an update on this very same case now coming up for review by an Administrative Law Judge (ALJ).

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

• 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.
• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
• SDoH Report: Ellen Fink-Samnick, who stepped down recently as the Monitor Mondays and RACmonitor subject matter expert on the social determinants of health (SDoH), will return to the broadcast for a one-time-only appearance, sitting in for Tiffany Ferguson. 

It’s an amazing spectacle being played out on network television news, talk radio, and cable news outlets: the tug-of-war between the Biden Administration and the Supreme Court. So, the question remains: when is a mandate not a mandate? 

 The back-and-forth over the Centers for Medicare & Medicaid Services (CMS) vaccine mandates for a wide range of healthcare providers has reached a conclusion, at least temporarily. After recent oral arguments, the Supreme Court has reinstated these CMS mandates. As such, RACmonitor’s and Monitor Mondays’ own Dr. John Hall, an attorney and physician, will have an important update and practical recommendations to help ensure that your facility is in compliance during the next edition of the weekly Internet radio broadcast.

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

•  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. 
• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
• 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.

Public schools and facilities will be closed. Church bells will chime, while a number of flags will fly at half-mast.  Because in 1983, former Republican President Ronald Reagan proclaimed that the third Monday of January would forever be observed as Martin Luther King Jr. Day.

This coming Monday, Jan. 17, Monitor Mondays will honor the slain civil rights leader with a special report recognizing efforts by various stakeholders to advance a variety of initiatives designed to improve health equity in America.

Reporting on how communities of color can benefit from regulatory efforts by the Centers for Medicare & Medicaid Services (CMS) and related federal agencies will be Lenel James, a business lead for Health Information Exchange & Innovation for the BlueCross and BlueShield Association (BCBSA). Mr. James was formerly associated with the Region V Regional Health Equity Council of Department of Health and Human Services (HHS) Office of Minority Health. In addition, he previously served on the Board of the Cosmopolitan Chamber of Commerce in Chicago, the second largest African American Chamber of Commerce in the US.

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

• 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.
• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report. 
• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
• 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 the healthcare regulations and the SDoH.

With the calamitous year of 2021 now in the rearview mirror, slowly receding from view, its legacy is expected to have a haunting effect, now and in the future, on America’s system of healthcare. And decisions being made in Washington, D.C. will impact every practice, facility, and health system for months or even years to come.

With so many major changes expected to take place in 2022, you need to stay informed and alert – and RACmonitor and Monitor Mondays will help you stay out in front of the issues that will alter the delivery of healthcare, both now and throughout a new year that has arrived amid a time of unprecedented uncertainty.

During the next edition of Monitor Mondays, broadcast host and RACmonitor Publisher Chuck Buck will have an all-star lineup of experts on hand to tell you what to watch out for, marking the 2022 premiere for the weekly Internet broadcast, which is celebrating 12 years of live programs.

Segments to be featured during the live broadcast include the following:

• Coronavirus Update: Frontline physician Dr. John Foggle will provide a real-time update on the mysterious omicron, the extraordinarily contagious variant of the coronavirus that has gripped the nation.
• Home Health and Hospice: William Dombi, president of the National Association of Home Care and Hospice, will report on the impact of COVID-19 and the public health emergency (PHE) on his Association’s members.
• Medicare Advantage Report: Medicare Advantage (MA) auditors are being called, by some, nothing short of bullies. Senior vice president of clinical and regulatory affairs for Versulas Health, will report why this bulling behavior exists and how providers should deal with this ongoing issue.
• IRF: One of the nation’s foremost authorities on inpatient rehabilitation facility (IRF) services, Angela Phillips will return to report on the resumption of IRF reviews by Recovery Audit Contractors (RACs).
• The Special Report: Who really does own the medical record? Dr. John Zelem, founder and CEO for Streamline Solutions Consulting, will report on this controversial issue, seeking to perhaps finally resolve the decade-old mystery.
• The Roche Report: RACmonitor investigative reporter Edward C. Roche will return with an exclusive story he’s uncovered while monitoring audit misbehavior nationwide from his perch in the Big Apple.
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications of the recently passed surprise billing law.
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.
• SDoH Report: Tiffany Ferguson, a subject matter expert on the social determinants of health (SDoH), will make her Monitor Mondays debut appearance, filling the shoes of Ellen Fink-Samnick, who has long reported on this timely topic with clarity and insight, but will be leaving her post as she completes her doctorate degree. Ferguson will report on the news that’s happening at the intersection of the coronavirus and the SDoH.