Monitor Mondays

Waivers from regulations, dire shortages of ICU beds, and scarce personal protective equipment (PPE), including gloves, gowns, and masks, are all part of the new normal as the coronavirus (COVID-19) continues to generate global headlines, especially in the United States.

Amid a cacophony of misinformation, providers and patients are searching for clarity in this fog of war. That time has come. Next Monday, the long-running and authoritive voice of healthcare regulation, Monitor Mondays, will broadcast a live, 60-minute town hall, during which its panelists will answer your questions and those of your colleagues.
The broadcast rundown will include updates from the following, and then segue to the town hall. 

Participating in the special news update will be the following:

• Rural Health Crisis: The global pandemic that is the coronavirus is spreading to the wide-open spaces of rural America, threatening the very existence of hospitals, caregivers, and patients. Reporting on this crisis will be the vice president of government affairs and policy for the National Association of Rural Health, Brock Slabach.
  
  
• RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report. Emanuel is expected to report on auditing activities by third-party auditors during COVID-19.
  
  
• Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, will report on contingency planning during the pandemic.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on how hospitals should respond to the homeless population presenting in emergency departments during the COVID-19 crisis. 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, will report on the $2 trillion COVID-19 economic stimulus deal passed by the Senate on Wednesday and expected to be voted on by the House on Friday.
  
  
• 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 problematic issues facing providers during the global pandemic, which has now resulted in more than 1,000 U.S, deaths.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

During this of Monitor Mondays, senior healthcare analyst Frank Cohen, a computational statistician, reports on how anecdotal thinking is not evidence-based thinking, and it is difficult to draw conclusions without having all of the information – noting that’s exactly what is happening right now, as America grapples with the coronavirus (COVID-19).

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

• RAC Report: Healthcare attorney Knicole Emanuel files her Monitor Mondays RAC Report.
  
  
• Audit Report: Sean M. Weiss, reports on the next audits you can expect to encounter.
  
  
• SDoH Report: Ellen Fink-Samnick, has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Matthew Albright reports on current healthcare legislation – proposed, pending, or passed – and its intended consequences.
  
  
• 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, makes his Monday Rounds with another installment of his popular segment which he discusses swing beds, Telehealth and billing under COVID19.

Converting Medicare patients from inpatient to outpatient status is a compliance issue. And hospitals need to know how to process the proper billing level of care for beneficiaries. Using their benefits correctly is a responsibility, since these patients rely on caregivers to advocate for them.

To help navigate these potential audit traps, we asked Mary Beth Pace, vice president of care for Trinity Health, to be our special guest during this edition of Monitor Mondays.

Other segments to be featured on the podcast:

• COVID-19 Update: Dennis Jones, director of patient financial services for Montefiore Nyack Hospital, reports on how the state of New York is working to remove barriers to the testing of the deadly virus.
  
  
• 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 will also conduct the Monitor Mondays Listener Survey.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis, join the broadcast as a permanent guest and report on current healthcare legislation – proposed, pending, or passed – and its intended consequences.
  
  
• 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. 

Seldom does a week pass without news about a pharmaceutical giant engaged in corporate wrongdoing. This week, the feds announced that they had filed a complaint under the False Claims Act (FCA) against Mallinckrodt ARD LLC. The complaint alleges that the pharmaceutical company “avoided paying hundreds of millions of dollars in Medicaid rebates due to significant drug price increases” as a result of “large increases in the price” of its drug H.P. Acthar Gel.

Recently, pharmaceutical company Sanofi-Aventis U.S., LLC, agreed to pay $11.85 million to resolve allegations that it violated the False Claims Act by paying kickbacks to Medicare patients through a purportedly independent charitable foundation, The Assistance Fund. And earlier, as reported by RACmonitor, electronic health records provider Practice Fusion Inc. agreed to pay a total of $145 million to resolve criminal charges and civil claims that it solicited and accepted unlawful kickbacks from pharmaceutical companies.

During this edition of Monitor Mondays, famed whistleblower attorney Mary Inman continues her reporting on the misdeeds of big pharma, with an update on the aforementioned Sanofi-Aventis FCA case.

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.
  
  
• Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports on the next audits you can expect to encounter.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis reports on current healthcare legislation – proposed, pending, or passed, and its intended consequences.
  
  
• 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 makes his Monday Rounds with another installment of his popular segment.

Contentious and confusing, the Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule will become effective Jan. 1, 2021.

On the surface, the requirements are straightforward: hospitals and health systems must make accessible all negotiated managed care rates in a machine-readable format, along with a list of 300 “shoppable” items –non-urgent, high-volume items and services – on their website or via an interactive tool for consumers. But below the surface lurks confusion. That is why we asked Frederick Stodolak, the president of Panacea Healthcare and a subject matter expert on hospital pricing, to be our special guest during this edition of Monitor Mondays.

Other segments featured on the podcast:

• Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will join the broadcast as a permanent guest and reports on current healthcare legislation: either proposed, pending, or passed, and its anticipated consequences.
  
  
• RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. 
  
  
• SDoH Report: Ellen Fink-Samnick, has the latest on the social determinants of health (SDoH) specifically with pediatrics.
  
  
• 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 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.

Like a destructive earthquake, recent news from The Chartis Center for Rural, documenting the accelerated rate of closures among rural hospitals, is sending shock waves through rural communities.

As with the Richter scale, the closure of one rural hospital is likely to have an exponential impact on all rural health. And the stark reality is that, as of January 2020, a total of 120 rural health facilities have closed their doors.

Leslie Marsh, the chief executive of Lexington Regional Health Center in Lincoln, Neb., returns to Monitor Mondays and reports on precipitous peril for rural hospitals, which is now rising to a national disaster.

Other segments featured on the podcast are:

• RAC Report: Senior healthcare analyst Frank Cohen returns to the broadcast to report on why Recovery Audit Contractors (RACs) can’t be considered unbiased in a court of law.
  
  
• Audit Report:  Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports Artificial Intelligence (AI) and its impact on compliance and auditing.
  
  
• Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrickson & Bryon, will join the broadcast with his trademark segment Risky Business.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

With a 30,000-foot view of rural healthcare policies and regulations emanating from Washington, D.C., Leslie Marsh still recognizes the importance of having boots on the ground, serving as the chief executive of Lexington Regional Health Center in Lincoln, Neb.

Marsh, who also serves as vice president of board of directors for the ruralMED Health Network, addresses the ubiquitous Z codes and their impact on the rural population, among other serious issues facing rural healthcare providers, during this edition of Monitor Mondays.

Other segments to be featured during the podcast includes:

• 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 the latest on Target Probe Educate.
  
  
• SDoH Report: Ellen Fink-Samnick has the latest news on rural health and also conducts the Monitor Mondays Listener Survey.
  
  
• Risky Business: Healthcare attorney David Glaser has 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. 

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.