Monitor Mondays

America’s hospitals are currently facing a critical challenge: a flood of patients placed under observation, leading to lost revenue and operational disarray. Amid the confusion, questions arise. Even seasoned bedside physicians struggle with uncertainty in determining patient status upon admission.

But fear not! There is hope in this chaotic landscape, unlocked by empowering the bedside physician to invoke the full potential of the Centers for Medicare & Medicaid Services (CMS) Two-Midnight Rule.

During the next live edition of Monitor Mondays, Dr. Stephanie Van Zandt from BayCare Health System in Florida will report on an innovative four-part process meticulously crafted by her team. She will explain strategies aimed at empowering emergency department (ED) providers and admitting hospitalists through comprehensive education on patient status determination.

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, federal legislative analyst for Zelis, will report on current healthcare legislation.

There was a time when everyone in healthcare compliance and revenue cycle management was scrambling to implement the Hospital Price Transparency Rule.

Now, nearly four years later, it’s back.

The Centers for Medicare & Medicaid Services (CMS) 2024 Final Rule for Price Transparency marks the biggest change to the rule requirements since it initially took effect in January of 2021.

The new mandate introduces a three-phase approach that began in January and will continue with new requirements effective in July, with additional requirements starting in January 2025. New technical mandates will introduce new challenges for hospitals, potentially forcing facilities out of compliance and creating a need for outside expertise to dig up pricing information and generate new data formats.

With the new mandates will also come increased numbers of CMS audits, warning letters, and non-compliance notices, as the federal government begins to automate the auditing process.

During the next live edition of Monitor Mondays, Jory Hatten, CEO for ClaraPrice, will report on this topic of vital importance.

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, state legislative analyst for Zelis, will report on current healthcare legislation.

What happens if the Supreme Court of the United States (SCOTUS) dismantles decades of government agency discretion? Recent cases at SCOTUS indicate that this could happen. But what would be the consequences?

During the next live edition of the long-running Internet radio broadcast Monitor Mondays, RACmonitor’s own physician and attorney Dr. John K Hall will consider the ramifications of the demise of the so-called “Chevron Deference” currently enjoyed by federal agencies.

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, federal legislative analyst for Zelis, will report on current healthcare legislation.

The implementation of generative artificial intelligence (AI) in the Electronic Health Record (EHR) is one of several hot-button issues to be explored during the next live edition of the Monitor Mondays, the long-running Internet broadcast produced by RACmonitor.

Other high-level considerations to be reported include leveraging AI in regulatory compliance, creating physician notes from doctor-patient conversations, and how AI could bridge knowledge gaps.

Reporting on these latest developments in healthcare technology will be senior healthcare consultant Sharon Easterling. Since 2012, Easterling has played a pivotal role in supporting companies as they integrate natural language processing (NLP) and machine learning into their coding and clinical documentation integrity (CDI) technology, utilizing algorithms. During the broadcast, her focus will be more sharply focused on advancing initiatives within healthcare AI and leveraging AI 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: Matthew Albright, federal legislative analyst for Zelis, will report on current healthcare legislation.

The Merit-based Incentive Payment System (MIPS) uses a composite performance score to determine if eligible physicians will receive a payment bonus, a payment penalty, or no payment adjustments. So, what’s the score for your physicians? Do they know?

During the next live edition of the long-running Monitor Mondays, Leigh Poland, vice president of coding services for AGS Health, will report on why it’s essential for all eligible clinicians to report their score to prevent a 9-percent downward adjustment for all Medicare Part B claims paid two years from the reporting year.

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: Kate Brantley, state legislative analyst for Zelis, will report on current healthcare legislation.

• Lead Story: Leigh Poland, vice president of coding for AGS Health, will report on the importance of physicians reporting their MIPS scores.

Auditors use the Comprehensive Error Rate Testing (CERT) study from the Centers for Medicare & Medicaid Services (CMS) as a way to target individual providers for potential recoupment. For example, if you get paid millions of dollars for some procedure codes or DRGs that have high error rates, it increases the likelihood that those specific codes and/or DRGs will be audited. Why? Because, statistically speaking, whatever the error rate reported by CERT is can help estimate the potential improper payments made to a given provider and/or organization.

During the next live edition of the venerable Monitor Monday broadcast, senor healthcare analyst Frank Cohen will return to continue his series on CERT.

Broadcast segments will 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 analyst for Zelis, will report on current healthcare legislation.

•Lead Story: Senior healthcare analyst Frank Cohen will continue with his reporting on the CMS program CERT.

What’s important to know about the Comprehensive Error Rate Testing (CERT) program from the Centers for Medicare & Medicaid Services (CMS) is that auditors rely upon the results to target specific providers for recoupment audits.

The more you know about CERT and the study results, the better position you will be in when it comes to understanding both the general risk of an audit and the specific areas that might be at risk within your organization, according to senior healthcare analyst Frank Cohen. Cohen, long associated with Monitor Mondays, will return to the famed weekly Internet broadcast this coming Monday to begin a series on CERT: the Good, the Bad, and the Ugly.

Broadcast segments will 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, federal legislative analyst for Zelis, will report on current healthcare legislation.

•Lead Story: Senior healthcare analyst Frank Cohen will return to Monitor Mondays to begin a new series on the CMS program CERT.

Will the World Health Organization (WHO) be given the power to impose restrictive pandemic measures on countries, including the United States? Will it be legally binding? What are the challenges and opportunities for healthcare providers in the United States, and how will this be enforced?

The member states of the WHO have been working on a plan of action when faced with the next pandemic. Negotiations are underway now, and their outcome will be submitted to the 77th WHO Assembly in May.

RACmonitor investigative Edward M. Roche will report the latest on this possible international compliance issue during the next live edition of Monitor Monday. 

Broadcast segments will 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 & Bryon, will join the broadcast with his trademark segment.

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

· Lead Story: RACmonitor investigative reporter Ed Roche will report on potential international compliance rules in the event of another global pandemic.

No more eggnog. Toss the champagne bottles. The good times are over, and now it’s back to business. But not business as usual. 

As the rest of the nation’s healthcare professionals clocked in for overtime, claims auditors were scrutinizing medical records, looking for the slightest inconsistency upon which to pounce. Now, nearly four weeks since its last news broadcast, Monitor Mondays will return this coming Monday with a cadre of the smartest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – except here and in RACmonitor.

Broadcast segments will 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 & Bryon, will join the broadcast with his trademark segment.

· Home Care and Hospice: William Dombi, president and CEO for the National Association for Home Care and Hospice, will report on the latest news concerning Medicare home health and hospice but also Medicaid’s Home & community-based services (HCBS).

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

·Docs and Regs: Monitor Mondays’ own physician and attorney, Dr. John K. Hall, will report on the impact of artificial intelligence on healthcare.

· Tech Report: RACmonitor investigative reporter Edward M. Roche will report on the latest technology trends impacting America’s healthcare delivery system.

· Lead Story: Frank Cohen, founder of the Frank Cohen Group will report on his recent study about how major changes to the 2021 evaluation and management (E&M) services is impacting 2024 E&M coding and compliance.

“He’s making a list, checking it twice…”

With a nod to the legendary Tin Pan Alley composer Haven Gillespie, who penned the lyrics to the iconic holiday song, senior healthcare consultant Ronald Hirsch, MD has been making his own list of healthcare professionals all year, paying close attention to their deeds in the field of healthcare.

Calling them “Hirsch’s Heroes,” an annual tradition that began in 2015, Hirsch will reveal those to whom he has bestowed the esteemed honor during the next live edition of Monitor Mondays. So far, 15 distinguished individuals have been named “Hirsch’s Heroes.” This year, the loquatious Hirsch will only say for now that the 2023 heroes will be a physician, an attorney, and two revenue cycle professionals.

Other broadcast segments will include these instantly recognizable features:

· The RAC Report: Healthcare attorney Knicole Emanuel 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, state leglistative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

RACmonitor investigative reporter Edward M. Roche, an intrepid regular monitor of America’s healthcare system, will return to Monitor Mondays for its next upcoming edition to report on how and why America’s healthcare system has tied itself into a Gordian Knot of complexity: interwoven strands of conflicting rules and regulations, different payments for the same services, and a cumbersome patchwork quilt of facilities, big, small, and smaller. Roche, who recently introduced to Monitor Mondays listeners the concept of “smart hospitals,” will also take a stab at answering a key question: just how smart are they?

Other broadcast segments will include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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 leglistative affairs analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

The annual 2023 MDaudit Benchmark Report has been published, and it is relevatory in its analysis of articial intelligence (AI) and its impact on payment and revenue integrity. According to the report, the primary topic of discussion for the next live edition of the long-running Monitor Mondays Internet broadcast, the implications of AI are immense when predicting its application to audit workflows – which is expected to impact outcomes for both providers and payers.

MDaudit CEO Ritesh Ramesh will appear as the special guest on Monitor Mondays to discuss the latest findings from the annual survey and how AI may impact healthcare revenue, including external payer audits and the detection of compliance and payment risks.

Other broadcast segments will include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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, federal analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

To quote the titular lyrics of the song popularized by Frank Sinatra for his very first No. 1 hit, “it was a very good year.”

The U.S. Department of Justice (DOJ) announced that more than $2 billion in False Claims Act settlements and judgments were reported in the 2023 fiscal year.

According to the DOJ, government and whistleblowers were “party to 351 settlements and judgments,” the second-highest number ever recorded in a single year.

Providing a roundup of those settlements and judgments during the next live edition of Monitor Mondays will be famed whistleblower attorney Mary Inman, a popular and respected correspondent.

Of note, more than $1.7 billion of that 2 billion were matters pertaining to the healthcare industry.

What can you do to protect yourself and your facility from the possibility of violating the False Claims Act? Listen to the next live edition of Monitor Mondays to find out.

Other broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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, state legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

The Two-Midnight Rule was first announced 10 years ago, October 2013, by the Centers for Medicare & Medicaid Services (CMS). Even today, though, the Rule remains an ongoing source of confusion for physicians as well as revenue cycle and finance experts.

However, it also will take on new importance, as CMS promises that Medicare Advantage (MA) plans will begin to follow the Rule in 2024.

During the next live edition of the popular and long-running Internet broadcast Monitor Mondays, physician and attorney Dr. John K. Hall will summarize the current state of the Two-Midnight Rule and offer insights of its use into the next decade.

Other broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The Whistleblower Report: Famed whistleblower attorney Mary Inman, partner in the law offices of Constantine Cannon, will report on the latest news concerning whistleblowers.

• The RAC Report: Healthcare attorney Knicole Emanuel 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 analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Violence in America’s hospitals is an issue that is squarely on the minds of hospital administrators and staff. And the violence seen in our society has increasingly encroached into the medical workplace. This violence can be verbal, it can be physical, it can be disturbing, and it can be deadly. The escalation and prevalence of violence in hospitals has had a major impact on employees, patients, and families.

During the next live edition of Monitor Mondays, senior healthcare executive Dennis Jones will report on new regulatory initiatives, individual hospital actions, and one sweeping policy by a state hospital association – all aimed at making hospitals safer places to work.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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 Brandley, state legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Congress and the Biden Administration continue to take a keen interest in issues related to prescription drug access and pricing. There is evidence of recent movement on Capitol Hill toward legislation aimed at addressing drug shortages affecting the healthcare system.

The government also is implementing a plan Congress approved last year to lower the prices Medicare will pay for certain drugs. For an exclusive update, register now to listen to the next edition of Monitor Mondays, when Maureen Testoni, president and CEO of 340B Health, will report on some of the latest Washington developments on these issues, including how they might affect the safety-net hospitals that deliver many of these drugs to patients.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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, federal legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

So far in October, the U.S. Department of Justice (DOJ) has been very busy, securing settlements, pleas, and convictions ranging in value from $25 to $350 million.

And just this month, DOJ announcements have featured settlements related to Anti-Kickback and Stark violations, as well as convictions in genetic testing schemes and guilty pleas for fraud involving unnecessary testing.

During the next live edition of Monitor Mondays, RACmonitor’s own physician and attorney, Dr. John K. Hall, will break down some of these recent reports to give you additional insights and help you understand your own risk.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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: Folana Houston, assistant general counsel for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

Coinciding with National Breast Cancer Awareness Month (October), RACmonitor investigative reporter Edward M. Roche recently went to the laboratories of Memorial Sloan Kettering to investigate one of the most exciting scientific developments of the decade.

Roche, who was among the first to introduce the healthcare compliance world to algorithms, artificial intelligence (AI), and “smart” hospitals, said that the molecular biological approach to cancer treatment represents a true scientific breakthrough. He also recounted the three standard treatment stages in America’s efforts to combat breast cancer: surgery, radiation, and chemotherapy. Each of these treatments, according to Roche, can have substantial and sometimes devastating side effects. Now, developments in molecular biology carry the potential to sweep away these approaches and leave patients healthy with a bare minimum of discomfort. But the question remains: when all is said and done, will America’s healthcare insurance companies reimburse providers for these services?

Roche will outline these issues as the featured guest during the next live edition of Monitor Mondays.

Broadcast segments will also include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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, federal legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

The Centers for Medicare & Medicaid Services (CMS) is on record saying that Medicare Advantage (MA) payers must follow the Two-Midnight Rule as of Jan. 1, 2024. Yet, it has been reported by multiple hospitals that their MA plans have said their lawyers tell them that they do not have to follow the CMS directions on the Rule relative to inpatient status, claiming their contracts govern their relationships and coverage issues with hospitals.

During the next live edition of Monitor Mondays, Dennis Jones, senior director of revenue cycle (a single business office) for Jefferson Health, will report on the arguments that seem to be iginiting a firestorm on the Internet.

Broadcast segments will include these instantly recognizable features:

• Monday Rounds: Dr. Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.

• The RAC Report: Healthcare attorney Knicole Emanuel 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, state legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.

It’s little wonder that we will be reporting on artificial intelligence (AI)during the next live edition of Monitor Mondays. We were among the first to report on algorithms in claims auditing.

But now, with so much attention being paid by the general news media to AI, its role in healthcare is gaining even greater attention and traction. So, during next live edition of our weekly Internet radio broadcast, we will take a deep dive into the role of AI and its use in auditing medical claims for accuracy and compliance when Blake Wylie, chief technical officer for Clarity Ventures Group, joins the broadcast.

By utilizing machine learning algorithms, auditors can sift through vast amounts of data to identify discrepancies and errors, thereby enhancing the overall reliability and efficiency of the medical billing process.

Broadcast segments will include these instantly recognizable features:

• Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.
  
  
• The RAC Report: Healthcare attorney Knicole Emanuel will report the latest news about auditors.
  
  
• Risky Business: Healthcare attorney Geoffrey Koslig, associated with law offices of Fredrikson & Byron, will substitute for David Glaser, to share his perspective on business issues that might appear (and in many cases, actually are) quite risky.
• Special Report: Govind Goyal, president of financial services for Panacea Healthcare Solutions, will report on the latest news about the beleaguered Hospital Price Transparency rule.
  
  
• Legislative Update: Adam Brenman, federal legislative analyst for Zelis, will report on the latest legislative actions impacting the healthcare regulatory setting.
  
  
• Lead Story: RACmonitor investigative reporter Edward M. Roche will report the lead story on the performance scorecard for Medicare.