Pick up any healthcare news feed or relevant state or federal initiative, and no doubt you will see the "surprise billing" issue headlining. The issue of a patient not knowing that a provider is not in their network is important, but there is another major cause of surprise bills: insurance plans denying legitimate claims for emergency care as "non-emergent." 

Prudent acts among patients are ignored, common sense is discarded, and ethical conduct is cast aside in order to insist that patients pay astronomical bills for services that truly constitute emergency care. 

These battles can take years. One such case will be discussed during this edition of Monitor Mondays; reporting our lead story will be Holly Louie, herself once an emergency department nurse.

Other segments to appear on the broadcast include:

• Monday Focus: Bogus Charity Write-offs: The Patient Protection and Affordable Care Act (PPACA) created a new provision in Section 501 of the Internal Revenue Code that applies to facilities licensed as hospitals under state law, with new requirements for uncompensated care. The law also imposed new reporting requirements on hospitals. Running afoul of this issue could be a significant compliance violation, as you’ll learn when Timothy Powell reports on what many experts believe could be a major compliance bust.
  
  
• United Behavioral Health Lawsuit: On Tuesday, a federal court in California found that United Behavioral Health (UBH) denied claims based on internally developed medical necessity criteria that were far more restrictive than generally accepted standards for behavioral healthcare. Famed whistleblower attorney Mary Inman, a partner in the London office of Constantine Cannon, will have the latest news on this major story.
  
  
• Extrapolation Changes: The Centers for Medicare & Medicaid Services (CMS) made significant changes in statistical sampling methodology for overpayment estimation. Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, reports on the changes and what they mean to providers
  
  
• Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular 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.