Monitor Mondays

Imagine machine learning and natural language processing deployed to audit claims.

Today, it’s the new reality.

Autonomous coding is dramatically altering the treacherous auditing landscape. So, how can you protect your facility from takebacks?
How do you maintain coding excellence to remain compliant?

Join this coming Monday, March 16 for the next live edition of the venerable Monitor Mondays Internet broadcast, when senior healthcare analyst Frank Cohen will describe the inner workings of autonomous coding. Cohen will also explain how to survive in today’s unforgiving audit landscape, which has become a habitat for advanced technology.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Healthcare documentation is no longer written for a single audience. Today, the medical record must simultaneously meet federal regulatory requirements and the coverage expectations of individual payers.

While these systems often overlap, they originate from different authorities and serve different purposes. One governs compliance and program integrity; the other determines whether services are approved and reimbursed.

As prior authorization expands and audit scrutiny intensifies, hospitals are increasingly navigating both systems at once. Understanding the distinction between regulatory documentation standards and payer-driven requirements is becoming essential for aligning clinical workflows, documentation practices, and operational strategy in today’s healthcare environment.

During the next live edition of the venerable Monitor Monday, the  live Internet broadcast, senior healthcare consultant Penny Jefferson returns to the broadcast to explain what many today are calling the new face of healthcare.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

The Centers for Medicare & Medicaid Services (CMS) has launched a new initiative titled Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).

CRUSH is a sweeping fraud prevention program. In an official news release posted Thursday, CMS reported suspending $5.7 billion in suspected fraudulent Medicare payments, preventing $1.5 billion in DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) billing, revoking more than 5,500 providers’ billing privileges, and denying 122,000 claims that failed medical necessity checks.

This latest news, including a nationwide DMEPOS enrollment moratorium and a $259.5 million Medicaid funding deferral, signals a decisive shift toward real-time enforcement.

What does CRUSH mean for providers, revenue cycle leaders, and compliance teams?

Senior healthcare consultant Penny Jefferson will be the special guest during the next live edition of the long-running news and information national podcast Monitor Mondays. Jefferson, the director of clinical documentation integrity (CDI) services for the University of California Davis Medical Center, will report on this new and developing story.

The broadcast will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Prior authorizations among Medicare Advantage plans have drawn criticism and concern from patients, providers, lawmakers, and regulators. But hospitals and doctors are uniquely positioned to advocate for their patients’ access to and coverage for care. What’s necessary is the need to understand the rules of the process. And Medicare Advantage plans have many of them.

During the next live edition of the venerable Monitor Monday, the Internet broadcast, Richelle Marting, a healthcare attorney, and certified coder, will help you understand when and how Medicare Advantage plans can use prior authorizations for the critical protections you need to know to advocate for patient care.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.

• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

• Legislative Update: Matthew Albright of Zelis, will report on current healthcare legislation.

In a January 28 article, Dr. Ronald Hirsch verified that the Centers for Medicare and Medicaid Services (CMS) “has no problem” with the Aetna Severity Payment policy because it “meets the Two-Midnight Rule.” 

However, there is more to consider than compliance with 42 CFR 412.3. 

Federal regulations also state Medicare Advantage organizations must comply with Traditional Medicare laws including payment criteria for inpatient admissions at 42 CFR 422.101(b)(2). So the burning question remains: Is CMS disregarding pertinent regulations that could nullify Aetna’s policy?

During the next live edition of the venerable Monitor Monday, the Internet broadcast, Cheryl Ericson, senior director of clinical policy and education for the Brundage Group, will address this apparent contradiction.

Broadcast segments will also include these instantly recognizable features:

·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. 

·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. 

·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

·      Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

It’s raining RACs.

The Recovery Auditor Contractors (RACs), together with an alphabet soup of other private and public auditors, are coming down hard on hospitals and physician practices, looking for omissions and errors in submitted claims.

Then there are seemingly contradictory rules from the Centers for Medicare & Medicaid Services (CMS).

It’s little wonder that providers are treading cautiously as they look to thread the needle of compliance.

This coming Monday, the venerable Monitor Mondays broadcast will present a cadre of the sharpest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – just here.

Broadcast segments will also include these instantly recognizable features:

·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. 

·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. 

·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

·      Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.

There was a time when Relative Value Units (RVUs) felt like a stable currency – something you and others could take to the bank. 

That was then. This is now.

Then, productivity could be measured, compensation plans could be managed, and economic models could assume relative stability in physician work measurement.

Recently, actions by the Centers for Medicare & Medicaid Services (CMS) – culminating in the 2026 Physician Fee Schedule – signal a philosophical shift in how physician work is valued, adjusted, and used as a policy lever. The takeaway is not that RVUs are broken; it is that they are no longer designed to be static. 

For more details on this change, the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of the venerated Internet broadcast, coming up on Monday, Feb. 2.

Broadcast segments will also include these instantly recognizable features:

·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. 

·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. 

·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.

·      Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

While many of you were enjoying the holidays, Kaiser Permanente was
back in the news. This time, another whistleblower case which resulted in
an amazing $556 million settlement to resolve allegations that the giant
provider/payer fudged on its Medicare Advantage risk adjustment.

Reporting the lead story during the next live edition of Monitor Mondays will
be Liz Soltan, a New York-based senior associate at Whistleblower
Partners. Soltan is a member of the firm's litigation team who represented
Dr. James Taylor in his landmark False Claims Act (FCA) case against
Kaiser Permanente which resolved allegations of Medicare Advantage risk
adjustment fraud. Soltan also works on a major Medicare Advantage risk
adjustment fraud case against UnitedHealth Group on behalf of
whistleblower Benjamin Poehling.

Broadcast segments will also include these instantly recognizable features:

 Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM,
will be making his Monday Rounds.

 The RAC Report: Healthcare attorney Knicole Emanuel, partner
at the law firm of Nelson Mullins, will report the latest news about
auditors.

 Risky Business: Healthcare attorney David Glaser, shareholder
in the law offices of Fredrikson & Byron, will join the broadcast with
his trademark segment.

 Legislative Update: Adam Brenman, legislative affairs liaison for
Zelis, will report on current healthcare legislation.

The Centers for Medicare & Medicaid Services (CMS) will block hospitals from performing certain interventions that are intended to change a child’s physical appearance to align an asserted sex identity.

Reporting the lead story during the next live edition of Monitor Mondays will be independent physician consultant Dr. Drew Updike.

More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday, Jan. 12, with a cadre of the smartest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – except here the RACmonitor.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.
  
  
• Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Whistleblower attorney Max Volman will return to the next Monitor Monday broadcast to report the latest news about whistleblowers. 

As we have learned, often “whistleblowers” are not insiders reporting wrongdoing; they tend to be outside the offending organization.

Register now to listen to Max Voldman’s exclusive report.

Broadcast segments will also include these instantly recognizable features:

●       Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. 

●       The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. 

●       Legislative Update: Adam Brenman, legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

●       Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.