The recent announcement by the Centers for Medicare & Medicaid Services (CMS)  that it will be “ramping up” audits are quickly becoming a reality for providers across the country. Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Unified Program Integrity Contractor (UPIC) auditors are going full steam ahead, using data and analytics to assess overpayments via automated reviews – and new language in UPIC letters paints an ominous picture for providers they deem non-compliant.

Reporting the lead story during this edition of Monitor Mondays is Sean M. Weiss of DoctorsManagement, who addresses these issues and the steps necessary to ensure a level playing field.

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

• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen also conducts the Monitor Mondays Listeners Survey.
  
  
• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins with his trademark segment, reporting on legal implications during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The Centers for Medicare & Medicaid Services (CMS) will reimburse a greater number of relative value units (RVUs) associated with office-based evaluation and management (E&M) visits, the agency announced recently.

In order to achieve budget neutrality, CMS will reduce the payment per RVU. With this change, CMS is allocating a larger proportion of its total spending to office-based physicians, at the expense of surgeons and hospital-based physicians.

Here’s the rub: organizations that utilize RVUs in their physician compensation arrangements and continue to pay the same 2020 rates per RVU on the increased number of 2021 RVUs will experience a dramatic decline in operating income. Reporting our lead story during this edition of Monitor Mondays is Adam J. Klein, who heads ECG’s Financial Services practice.

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

• Whistleblower Update: Famed whistleblower Mary Inman, partner in the law office of Constantine Cannon, returns to the broadcast to report on two whistleblower cases that have dropped from the radar screen, but nevertheless are essential for re-examination.
  
  
• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen will also conduct the Monitor Mondays Listeners Survey.
  
  
• 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.
  
  
• 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 during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Unlike the Cold War arms race between the then-Soviet Union and the United States, today’s arms race is being fought before computer monitors, and in the deep corners of computer laboratories. And the weapon of choice: algorithms.

This fierce fighting is taking place between auditors and providers, and the stakes are high: money. Lots of it.

No stranger to chronicling the former Cold War arms race, Edward Roche, RACmonitor’s investigative reporter, returns to the Monitor Mondays broadcast to report on how algorithms created by payers tend to foster a camouflage of mediocrity for providers.

Other segments to be featured during the podcast:

• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makesg his Monday Rounds with another installment of his popular segment.

In recent weeks, several major pharmaceutical manufacturers have taken actions that could lead to narrowing the 340B Drug Pricing Program, which provides outpatient drugs to safety-net hospitals, health centers, and clinics at discount prices. The savings are invested in care for patients with low incomes, living in rural communities.

The actions by Eli Lilly, Merck, and Sanofi are being challenged by a coalition of safety-net providers, including 340B Health, which represents more than 1,400 340B hospitals. Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health, who will discuss why she is concerned by these actions by drugmakers.

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

• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.
   
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

California is one of two states in the country that rewards whistleblowers for bringing forward information about private insurance fraud. A recent $24 million settlement with pharmaceutical giant Abbvie over the marketing of the company’s blockbuster drug, Humira, demonstrates the law’s effectiveness.

The settlement agreement was reached last week following allegations that the company violated California’s Insurance Frauds Prevention Act. Abbvie agreed to the settlement despite continuing to deny any wrongdoing.

On the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will provide details on this important news story.

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

• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The omnipresent coronavirus pandemic continues to upend lives, from mundane occasions like grocery shopping to long-planned space exploration missions. The pandemic is manifesting itself from the halls of Congress to the cubicles at Centers for Medicare & Medicaid Services (CMS) headquarters, to classrooms, theatres, homes, and places of worship, among other venues.

On the next live edition of Monitor Mondays, we will explore the impact of the coronavirus on audits and auditing, proposed rules, guidance, and waivers.

Joining the broadcast to report on anticipated pandemic-related audits will be Dr. John K. Hall, founder of The Aegis Firm, a healthcare consulting firm. Dr. Hall, also an attorney, will discuss these types of scenarios, and how to prepare for the inevitable denials coming your way.

Also during the 60-minute broadcast, you’ll hear from Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University, who will provide a much-needed perspective on the impact of the prolonged epidemic. And making her debut appearance on Monitor Mondays will be Julia K. Brodt, PhD, an educator and former epidemiologst, who will provide a layperson’s background on antibodies, which are fundamental in the quest for a vaccine.

Other segments to be featured during the podcast include:

• RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. 
  
  
• Audit Report: Sean Weiss, compliance officer for DoctorsManagement, returns to the broadcast with the Monitor Mondays Audit Report.
  
  
• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, reporting on legal implications during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.
  
  
• IRF Report: Angela Phillips, PT, president and chief executive officer for Image and Associates, reports on the the CMS final rule for the inpatient rehabilitation facility (IFR) prospective payment system for the 2021 fiscal year.

Center of Medicaid and Medicare Services (CMS) has been posting proposed rules for Medicare this past week. Already, CMS has issued the final rules for Inpatient Psychiatric Facilities, Skilled Nursing Facilities, and Hospices; and we are still awaiting the final rule on the Inpatient Hospital payment rules.
 
In light of these proposed rules we’ve asked two experts, Dr. Ronald Hirsch and Terry Fletcher to explain the significance of these proposals in a special Friday edition of Monitor Mondays.

This special edition of Monitor Mondays was sponsored by Dr. Ronald Hirsch. You can visit his website here: https://www.ronaldhirsch.com/ or you can purchase his 'Hospital Guide to Contemporary Utilization Review, Second Edition' at https://hcmarketplace.com/contemporary-utilization-review

While the battle cry of “defund the police” has emerged from Black Lives Matter activists following the death of George Floyd at the hands of Minneapolis police, could there also be sufficient reason for providers to advocate to “defund the Unified Program Integrity Contractors (UPICs)?”

According to RACmonitor investivative reporter Ed Roche, UPIC auditors are attacking osteopathic medicine, and might need lessons in reading patient notes. During the next live edition of Monitor Mondays, Roche will explore the seeming incompetence of auditors when they go after such providers. Osteopathic doctors help manage pain, but there may be no cure for an incompetent audit.

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

• COVID-19 Report: Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University, will provide an update on the pandemic that claimed the lives of more that 152,000 in the U.S.
  
  
• Audit Report: Sean Weiss, compliance officer for DoctorsManagement, will report on the latest wrinkle in the ongoing kerfuffle of telehealth and patient consent.
  
  
• 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.
  
  
• 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 during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Two major storylines are discussed during this edition of Monitor Mondays, with the exclusive 60-minute broadcast to focus on the raging coronavirus pandemic and the imminent auditing of Medicare and Medicaid claims scheduled to begin Aug. 3, as directed by the Centers for Medicare & Medicaid Services (CMS).

Joining the broadcast to report on the coronavirus will be Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University. Offering an update on the imminent audits of Medicare and Medicaid claims will be healthcare attorney Andrew Wachler, managing partner of Wachler and Associates. And Sean Weiss, chief compliance officer for DoctorsManagement, reports on the issues and implications associated with the public health emergency (PHE), which was extended recently by Alex Azar, Secretary of the U.S. Department of Health and Human Services (HHS).

Two reports from two provider organizations will round out the Monitor Mondays coverage of the impact of the deadly coronavirus on hospitals. Dennis Jones, administrator of patient financial services at Montefiore Nyack Hospital in Nyack, N.Y., once near the epicenter of the virus, reports on how his facility has emerged from the worst of the spike in the northeast. And Nicole Thorell, chief nursing officer at Lexington Regional Health Center, reports on how her rural hospital has managed to survive during the pandemic.

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

• RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, files the Monitor Mondays RAC Report.
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen also conducts the Monitor Mondays Listener Survey.
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment. reporting on legal implications during the pandemic. 
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.
• COVID Q&A: Navigating COVID-19 guidance continues to be a major challenge for healthcare professionals – and that is why Monitor Mondays will devote additional time during this live broadcast to answer your questions.

Could Alexander VS. Azar really be over? This week's Monitor Mondays episode we've called upon or resident healthcare attorneys Knicole Emanuel Esq., David Glaser Esq. and our guest host John K. Hall MD, JD to dissect and assess the complicated case.

The case has been disorganized since the beginning, possibly leaving more questions than answers. This Monitor Mondays round table will analyze procedural aspects of the case and what it could potentially mean for providers, analyze where the decision has risk for providers, and provide guidance of how providers should respond in the future.

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

• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest research from the Urban Institute and Robert Wood Johnson Foundation about Unemployment, and Loss of Employer-sponsored insurance. Ellen will also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will have the latest legislative news coming from Washington.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
  
  
• Court Report:  Mary Inman, Esq. has the latest report on Pfizer's charitable contributions and what future court rulings affect on the industry, and drug prices.