Monitor Mondays

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.

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.

The new rulemaking this so, 52 CFR, Section 424.519, Disclosures of Affiliations, authorizes CMS to deny or revoke enrollment based on disclosures of certain affiliations the agency determines to pose an undue risk of fraud, waste, or abuse.

Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates. Mr. Wachler also discusses what constitutes an “affiliated entity” and what events must be disclosed.

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 in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• Court Report: Famed whistleblower attorney Mary Inman reports on Tenet Healthcare’s proposed $66 million False Claims Act settlement. Inman is a partner in the London office of Constantine Cannon.
  
  
• Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey.
   
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Giant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.

The results of a study published last week by Science revealed what researchers identified as a "significant racial bias" in Optum’s algorithm, which reportedly undervalues the healthcare needs of black patients. Although Science didn’t mention Optum by name, other news organizations have confirmed that it was, indeed, Optum.

Reporting on this developing story during this edition of Monitor Mondays is RACmonitor investigative reporter and New York attorney Edward Roche, director of business intelligence for Barraclough New York LLC.

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 in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.
  
  
• Ring of Fire: Dr. Alvin Gore, the physician advisor at St. Joseph Health in Santa Rose, Calif., reports on disaster planning in the wake of horrific wildfires burning out of control in Northern California. Shortages of nurses who were ordered to evacuate is one of the many emergencies he continues to monitor as the fire rages.
  
  
• Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.
  
  
• SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.
  
  
• Monday Rounds: Substituting for Dr. Ronald Hirsch, is Dr. Howard Stein, associate director of medical affairs and physician advisor in care management at CentraState Medical Center in Freehold, New Jersey. 

A federal court on Tuesday found that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced payments for hospital outpatient services delivered outside of hospitals in outpatient provider-based settings. The Centers for Medicare & Medicaid Services (CMS) could appeal the court’s decision on its site-neutral payment rule for hospital outpatient services. Score one for hospitals, but the war is far from over.

Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.

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.
  
  
• E&M Coding Changes: Impending evaluation and management (E&M) changes for 2021 and their impact on coding and compliance professionals is reported by Shannon DeConda, founder and president of NAMAS.
  
  
• Monday Focus: Ransomware: Healthcare news has been rife with stories of bad actors from overseas planting ransomware in the business systems of hospitals and medical practices large and small. Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, reports on this ongoing problem and offers advice providers can take to mitigate the risk of global hackers.
  
  
• 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.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.