The artificial intelligence (AI) arms race is heating up. The use of AI by healthcare providers responding to a wave of audits initiated by AI systems is an escalation. As the government continues to deploy AI systems in Medicare audits, providers will respond with their own counter-measures, also using AI. Reporting our lead story during the next edition of Monitor Mondays will be RACmonitor investigative reporter Edward Roche, who continues to monitor the intensifying showdown. 

Other segments to be featured on the podcast include:

• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.
  
  
• Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, which he reports on problematic issues facing providers.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM,  makes his Monday Rounds with another installment of his popular segment. 

Practice Function, Inc., a unit of Allscripts Healthcare Solutions Inc., engaged in an "abhorrent" scheme to help a pharmaceutical company push its extended-release opioids, according to a news release posted on Monday by the U.S. Department of Justice.

The company agreed to pay $145 million to resolve criminal and civil investigations relating to its electronic health records (EHR) software. Practice Fusion admitted soliciting and receiving kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications. Famed whistleblower attorney Mary Inman reports our lead story this edition of Monitor Mondays.

Other segments to be featured on the podcast include:

• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• IRF Report: Angela Phillips, considered to be among the nation’s most recognized authorities on inpatient rehabilitation facilities (IRFs), provides a 2020 update on the many changes taking in place in the IRF world.
  
  
• SDoH Report: Ellen Fink-Samnick, has the latest news on social determinants of health (SDoH) and also conduct the Monitor Mondays Listener Survey.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

What once appeared to be a legislative slam dunk is now mired in controversy, this time fueled by the recently formed coalition dead-set against the proposed use benchmark payments.

The Coalition Against Rate-Setting considers the practice tantamount to price-fixing. What will happen next to the compromise legislation, which was hammered out with bipartisan congressional support? Matthew Albright, chief legislative affairs officer for Zelis, reports our lead story during this edition of Monitor Mondays.

Other segments to be featured on the broadcast include the following:

• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group. 
  
  
• Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter. Weiss joins the broadcast as a regular panelist, reporting on the ever-changing audit landscape.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers.   
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

AmerisourceBergen, one of the nation’s largest pharmaceutical wholesalers, must turn over records to pension fund shareholders probing to determine wrongdoing by the drug distributor’s board for the company’s multi-billion-dollar legal exposure from the nationwide opioid crisis.

AmerisourceBergen was already facing two congressional investigations, plus a Drug Enforcement Administration (DEA) probe. Reporting on this developing story is famed whistleblower attorney Mary Inman, a partner in the London law office of Constantine Cannon.

Other segments to be featured on the broadcast include the following:

• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.
  
  
• Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.
  
  
• SDoH Report: Ellen Fink-Samnick has the latest news on a report from NPR about life experience and income inequality in the USA. Ellen will also conduct the Monitor Mondays Listener Survey. 
  
  
• Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment where he will discuss the new Important Message from Medicare.

2020 ushers in a formidable decade of healthcare regulations and a perilous audit landscape, populated with aggressive auditors who will be aided by artificial intelligence to review and deny claims.

Decisions being made in Washington, D.C. will impact every practice, facility, and health system. With so many major changes taking place, 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 through this new and unchartered decade.

Monitor Mondays host and RACmonitor Publisher Chuck Buck will have the following all-star lineup of experts on hand to tell you what to watch out for in 2020, during the first broadcast of the year for the weekly Internet broadcast, which is celebrating 10 years of live programs. Our line up of panelists includes:

1. Dr. Ronald Hirsch, MD, FACP, CHCQM
2. Nancy Beckley, MS, MBA, CHC
3. Knicole Emanuel, Esq.
4. Maureen Testoni, Esq.
5. Stanley Nachimson, MS
6. Edward M. Roche, PhD, JD
7. Andrew Wachler, Esq.
8. Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP
9. Angela M. Phillips, PT
10. William A. Dombi, Esq.
11. Leslie Marsh, RN, BS, MSN, MBA 

Join us for a unique look behind the scenes with long-time Monitor Mondays moderator Clark Anthony as he interviews many of our esteemed panelists from the last 10 years.

It’s been a rough year for home health and hospice providers, especially in light of the fact that the Centers for Medicare & Medicaid Services (CMS) included a reduction in the base payment rate of 8.01 percent in the Patient-Driven Groupings Model (PDGM) of the 2020 Home Health Prospective Payment System Rate Update.

Returning to Monitor Mondays is William Dombi, president of the National Association for Home Care and Hospice, who will provide a regulatory update for his association as its members prepare for another year of audits.

Other segments to be featured on the broadcast include the following:

• Monday Focus: What are likely to be three major audit issues in 2020? Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reveals his pick of the top challenges you and your team will face in 2020.
  
  
• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest activities by the Recovery Audit Contractors (RACs) and other third-party Medicare claims auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. 
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, unveils his 2019 Hirsch’s Heroes: individuals who, in his judgment, made outstanding contributions in the world of healthcare over the last year.

Rural hospitals are an endangered species in America, with extinction a real possibility. 

In fact, the North Carolina Rural Health Research and Policy Analysis Center report that more than 120 hospitals have closed nationwide since 2005, with nearly 70 percent (or 83) of those closures occurring since 2010. Adding insult to injury is the recent announcement from the Centers for Medicare & Medicaid Services (CMS) that Monday, Dec. 2 is the deadline for critical access hospitals (CAHs) to submit a hardship exception to avoid the “Medicare downward payments.” To qualify, those hospitals must illustrate the use of certified electronic health record technology (CEHRT) in order to meet the reporting requirements of the Medicare Promoting Interoperability Program and demonstrate “meaningful” use.

Delivering a State of the Union report on America’s rural hospitals during this edition of Monitor Mondays will be Maggie Elehwany, vice president of government affairs and policy for the National Rural Health Association.

Other segments to be featured on the broadcast include the following:

• RAC Report: Healthcare attorney Knicole Emanuel will report on the latest activities by the Recovery Audit Contractors (RACs), and other third-party Medicare claims auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.
• Court Report: The U.S. Supreme Court recently turned away two cases that tested the scope of the False Claims Act. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon.
• Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers.
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. 

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.

“CMS has spent the last two years working on the IMPACT Act, and they are now ready to implement,” reports Mary Beth Pace, vice president of care management at Trinity Health. “Does the CoP resemble anything akin to what you thought they would come out with? It does not to us. Let me reflect on our initial shock, and then our action.”

For a field report on how one major health system is preparing for this major new policy, RACmonitor has invited Ms. Pace to be the special guest during the next edition of Monitor Mondays.

Other segments to be featured on the broadcast include the following:

• RAC Report: Healthcare attorney Knicole Emanuel will report on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six defendant managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.
  
  
• Fraud Report: The manager of multiple medical clinics in Brooklyn and Queens, New York, was found guilty for his role in a nearly $100 million healthcare kickback and money laundering scheme, according the U.S. Department of Justice. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon.
   
• Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers.
   
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Patient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care. 

Reporting the lead story during this episode of Monitor Mondays is Melinda Battaile, MD, physician advisor and clinical documentation advisor for Vidant Health in Greenville, N.C.

Other segments to be featured on the broadcast include the following:

• RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs).
  
  
• Monday Focus: Algorithms are a trending topic, made even more so with recent accusations of gender bias in the Goldman Sachs Apple Card leveled by presidential candidate and U.S. Senator Elizabeth Warren. RACmonitor investigative reporter and New York attorney Ed Roche returns to the broadcast to continue his reporting on algorithms and their use in claims auditing.
  
  
• Policy Update: The Centers for Medicare & Medicaid Services (CMS) intends to press forward with payment cuts for some hospital clinic visits, as well as cuts to the 340B drug discount program, despite an adverse court ruling in September. Matthew Albright, chief legislative affairs officer for Zelis, reports on this developing story.
   
• Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on CMS's final rule’s reference to “shoppable” services.
   
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.