Monitor Mondays

Welcome to the new normal. You and your team continue to be challenged by consequences of the coronavirus pandemic, dealing with PPE shortages, along with confusing and oftentimes contradictory guidance from the Centers for Medicare & Medicaid Services (CMS).

And now, we look onward – toward the audit horizon, and looming denials for COVID-related care. You need to be aware of ongoing payor expectations and potential risk areas for denials. Returning to Monitor Mondays to report our lead story during this edition of the weekly Internet radio broadcast will be Dr. John K. Hall, founder of The Aegis Firm, a healthcare consulting firm. Dr. Hall, also an attorney, discusses these types of scenarios, and how to prepare for the inevitable denials coming your way.

Other segments featured during the podcast:

• RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, reports the news that’s happening at the intersection of COVID-19 and SDoH. Ellen will also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Former CMS official Matthew Albright, reports on the status of key healthcare legislation.
  
  
• Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment.
  
  
• Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment.

Faced with rising numbers of COVID-19 cases, one hospital struggled to find adequate medical/surgical beds due to the challenges it had with discharging COVID patients. With a strong desire to address the need for surge capacity and to meet patient needs for inpatient rehabilitation, the challenge was met by the team at Henry Ford Macomb Hospital in Michigan, as you’ll learn during this edition of Monitor Mondays.

Longtime RACmonitor contributor Angela Phillips will report on how the hospital kept the Inpatient Rehabilitation Facility (IRF) open, providing much-needed rehabilitation services while assisting the organization in meeting the needs of an influx of COVID patients and managing throughput to open acute beds as needed. Phillips, long considered be one of the nation’s foremost IRF authorities, is the president and CEO of Images & Associates.

Other segments featured on the podcast:

• RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.
  
  
• Court Report: Famed whistleblower attorney Mary Inman reports on the recent court case that saw Med Analystic lose its battle to establish a new breed of corporate whistleblower outsiders.
  
  
• SDoH Report: Ellen Fink-Samnick, 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: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, reporting on risky business during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment.

New York City-based RACmonitor investigative reporter Ed Roche returned to Monitor Mondays to report on developments in contact tracing: one of the newest tools in the fight to contain the deadly novel coronavirus that causes COVID-19.

A hefty amount of money is being invested in contact tracing, including the development of new automated tools. But Roche reports his concern that some of the models being proposed may complicate how we exercise our Constitutional right to privacy.

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

• RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick 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: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic. 
  
  
• Risky Business: Healthcare attorney David Glaser, reports on when HIPAA does, and does not, limit the ability to publicly comment on a situation like a Covid Outbreak during his Risky Business segment.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.1qq

Long-term care providers nationwide are seeking to identify ways to mitigate the uncontrolled spread of the COVID-19 virus amid vulnerable populations. Case in point: “drop teams” of physicians, infection preventionists, and nurses that could be deployed to any post-acute care space that was felt to be at risk.

After seeing an outbreak at LifeCare Center in Kirkland, Wash., physician leadership and case management at MultiCare in Spokane, Wash. brainstormed ways to prevent a similar local occurrence.

During this edition of Monitor Mondays MultiCare’s Ben Kartchner, MD, reports on how the drop teams are working in the region – offering lessons learned from one of the nation’s coronvirus hot spots.

Other segments on the podcast include:

• RAC Report: Healthcare attorney Knicole Emanuel files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick reports on the news that’s happening at the intersection of COVID-19 and SDoH. Ellen will also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment, reporting on risky business during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD 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 devoted additional time during the live broadcast to answer your questions. 

While much of today’s healthcare news is righty focused on the efforts to stave off the global coronavirus pandemic, there is other news to report – and Monitor Mondays will have a complete wrap-up on all of it during the next edition of the weekly Internet radio broadcast, while also looking ahead.

And given the tendency of the Centers for Medicare & Medicaid Services (CMS) to issue waivers and guidance with a unique style of ambiguity, a great deal of confusion also continues to come from hospitals and health systems in their efforts to remain compliant – while at the same time tending to their mission of delivering patient care amid the crisis. So during this special 60-minute live edition, we’ll also have our panelists standing by to answer your questions.

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, will file the Monitor Mondays RAC Report.
  
  
• Monday Focus: Kathy Pride, executive vice president of coding and documentation services for Panacea Health, will report on two interim final rules, including an expansion and relaxation of guidelines for telehealth services.
  
  
  
• Court Report: Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will report on two prominent examples of the need for independent regulatory oversight: the removal of the Inspector General of the U.S. Department of Health and Human Services (HHS), and news that Rick Bright, former director of the Biomedical Advanced Research and Development Authority, has filed a whistleblower complaint with the Office of  Special Counsel, claiming that he was transferred to a “less impactful position” at the National Institutes of Health (NIH) after he was reluctant to promote the use of drugs such as hydroxychloroquine to treat COVID-19 patients.
  
  
• 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 regulatory ambiguity during the pandemic.
  
  
• Outpatient Therapy Update:  Nancy Beckley, president of Nancy Beckley and Associates, will return to the broadcast to report on inequities for outpatient therapy providers as it pertains to payment, reimbursement, telehealth, and service delivery.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment. 
  
  
• Special Report: RACmonitor investigative reporter Edward C. Roche, PhD, JD, will provide a status report on COVID-19 testing in the United States.
  
  
• 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. Returning to the broadcast will be Matt Lambert, MD, an emergency medicine physician and chief medical officer for Curation Health.

Pursuant to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the U.S. Department of Health and Human Services (HHS) has allocated $50 billion to providers and other healthcare facilities in the form of a one-time payment, which does not need to be paid back.

The payment comes with terms and conditions that recipients must follow, however, including permissible uses for the payment – and failure to follow the terms and conditions, including documentation requirements, may result in an audit or other allegations of fraud and abuse.

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

• RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick reports on the news that’s happening at the intersection of COVID-19 and SdoH. Ellen will also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative: Matthew Albright, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, reporting on regulatory ambiguity during the pandemic.
  
  
• Monday Rounds: Ronald Hirsch, MD, 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.

The global COVID-19 pandemic has presented a multitude of logistical challenges to healthcare providers across the country and beyond. But few are as daunting as the protocols utilization management (UM) directors are being asked to implement regarding patient status assignment.

Delivering a riveting report from the front lines of the pandemic during this edition of Monitor Mondays, Stephanie Van Zandt, MD, Medical Director and Physician Advisor with BayCare Health System, a nonprofit healthcare organization that connects Florida residents with services at 15 hospitals across the state.

Van Zandt describes the pitfalls and intricacies of the five-pronged policy she helped develop for BayCare as admissions continued to swell amid the pandemic, which has produced nearly 30,000 confirmed COVID-19 cases in the Sunshine State, along with nearly 1,000 deaths.

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

• RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.
  
  
• SDoH Report: Ellen Fink-Samnick, 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: Matthew Albright reports on the status of healthcare legislation associated with the current COVID-19 pandemic.
  
  
• Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, reporting on telehealth and private payers 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 have devoted additional time during the broadcast to listener questions.

“Although Office of Medicare Hearings and Appeals (OMHA) office space is closed to the general public, OMHA remains open for business with employees working under maximum telework flexibilities, per U.S. Office of Personnel Management guidance.” -OMHA website.

Indeed, “OMHA hearings and appeals processing measures are proceeding as scheduled,” the notice reads. “Unless an appellant is notified directly that a hearing has been postponed or canceled, appellants should continue to appear for hearings by telephone, as scheduled.”

Through teleconferencing and phone calls, many administrative law judges (ALJs) are exercising flexibility in rescheduling such hearings or granting extensions to file for a hearing. Furthermore, the Centers for Medicare & Medicaid Services (CMS) has suspended new Medicare fee-for-service audits through the duration of the public health emergency, as you’ll hear more about during this edition of Monitor Mondays. Reporting our lead story during the weekly broadcast will be Andrew Wachler, Esq., a familiar figure at OMHA and managing partner of Wachler & Associates.

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 will 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 Fredrickson & Bryon, joins the broadcast with his trademark segment, reporting on telehealth therapy.
• 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. 

Custodial admissions are problematic for hospitals under normal circumstances. But now, incredible demands placed upon facilities by COVID-19 create even more challenges, as you’ll learn during the next edition of Monitor Mondays – when Juliet Ugarte Hopkins, MD, will return to the broadcast as its special guest to report on the issues that are hampering efforts to keep hospital beds open for the patients who require care for their medical conditions.

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 will also conduct the Monitor Mondays Listener 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 Fredrickson & Bryon, will join the broadcast with his trademark segment, in which he reports on the impact of COVID-19 on America’s teaching hospitals.
  
  
• 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 the live broadcast to answer your questions. The COVID-19 Q&A is sponsored by Curation Health.

The 1,000-bed USNS Comfort, a hospital ship that in the past has provided humanitarian relief around the world, is now anchored on Pier 90 in Manhattan to provide humanitarian relief as COVID-19, the illness caused by the novel coronarvirus, ravages New York City, now the epicenter of the pandemic. Also in New York City, the famed Jacob Javits Center has been converted to a 1,200-bed field hospital by the U.S. Army Corps of Engineers. In the meantime, the White House is warning the nation to expect the worst, reporting that up to 200,000 deaths from COVID-19 could occur. As President Trump put it, “this is going to be a very, very painful two weeks.”

The broadcast includes the following updates, and then segue to the town hall:

• Alvin Gore, MD, CHCQM, is a physician advisor and director of utilization management at St. Joseph Health in Sonoma County, Calif, and also a member of the board of directors of the American College of Physician Advisors;
  
  
• Matt Lambert, MD, an emergency medicine doctor and the chief medical officer (CMO) for Curation Health;
  
  
• Dennis Jones, administrator of patient financial services for Montefiore Nyack Hospital in Nyack, N.Y., and a frequent panelist on Monitor Mondays and Talk Ten Tuesdays; and
  
  
• Howard Stein, DO, MHA, CHCQM-PHYSADV, associate director of medical affairs and a senior physician advisor at CentraState Health System in Freehold, N.J.
  
  
• Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on pending legislation in response to the 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, 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.