Monitor Mondays
361 episodes - English - Latest episode: 4 days ago - ★★★★ - 19 ratingsJoin Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when you’re listening to the long-running and popular Monitor Mondays. Register to attend live here: https://racmonitor.medlearn.com/racmonitor/podcasts/
Homepage Apple Podcasts Google Podcasts Overcast Castro Pocket Casts RSS feed
Episodes
The Two-Midnight Rule: Navigating Treacherous Medicare Currents
April 22, 2024 17:00 - 27 minutes - 19.1 MBLike seasoned harbor pilots navigating tugboats through natural and manmade hazards, physician advisors each day face the daunting task of guiding their hospitals through a labyrinth of Medicare rules and regulations. Reporting on those conditions during the next edition of Monitor Mondays will be the vice chair of the recently concluded national conference of the American College of Physician Advisors, Stephanie Van Zandt. In that role, Dr. Van Zandt had a front-row seat to the history-mak...
Defense Strategies Against AI Audits
April 15, 2024 16:00 - 40 minutes - 27.7 MBArtificial Intelligence (AI) software is now in the “hype phase” of adoption. It promises to increase the efficiency of medical audits. But also, AI is being touted as being able to handle much more data, examine many more cases, and instantly make decisions regarding medical necessity or inadequate documentation. The number of audits can be doubled, tripled, quadrupled. Why take samples for review when AI can audit every single claim submitted? Providers can expect a deluge of demands for...
Medicare Advantage “Schemes” in the DOJ Crosshairs
April 08, 2024 15:00 - 31 minutes - 21.4 MBThe recent $37 million settlement against Cigna regarding enhancing risk adjustment factor (RAF) scores —along with related litigation by the U.S. Department of Justice (DOJ)— highlight the aggressiveness of the federal government to crack down on entities for non-compliant billing practices. During the next live edition of Monitor Mondays, Dr. James Kennedy will unpack the challenges entities have with this hot billing compliance issue. Dr. Kennedy will also recommend an approach that atte...
Whistleblower Update: $300 Million in Alleged Fraud
April 01, 2024 16:00 - 31 minutes - 21.5 MBThe U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit that accuses Martin’s Point Health Care, along with five other providers in other states, of defrauding the government of more than $300 million, pertaining to allegations that the providers inflated patients’ risk scores to obtain higher payments to which they were not entitled from the government’s military health plan. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronal...
How to Achieve a Clear Vision for Hospital Price Transparency
March 25, 2024 16:00 - 29 minutes - 20.2 MBSince its launch in January 2021, the Hospital Price Transparency Rule from the Centers for Medicare & Medicaid Services (CMS) has been a vexing issue for many of America’s hospitals. Despite enforcement efforts from CMS, implementation for many providers has been onerous – so much so that when the latest requirements were issued by CMS, one could imagine provider executives simply giving up, rationalizing that non-compliance was the cost of doing business. But now there’s a chance for your...
The Fix is in: Hospital Price Transparency Rule
March 18, 2024 19:00 - 28 minutes - 19.6 MBMany of America’s hospitals continue to be challenged as it pertains to complying with the requirements from the Centers for Medicare & Medicaid Services (CMS) for implementing the agency’s rule on hospital price transparency. And that is why RACmonitor and Monitor Mondays are producing a three-part series, in collaboration with ClaraPrice, to help providers fix this vexing problem, including addressing the onerous requirement for hospitals to produce their own machine-readable files (MRFs)....
Empowering the Bedside Physician to Lower Observation Rates
March 11, 2024 18:00 - 30 minutes - 21 MBAmerica’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-Midnigh...
Hospital Price Transparency Rule: An Important Update
March 04, 2024 17:00 - 28 minutes - 19.9 MBThere 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 requirement...
Updated Episode | Chevron Deference: What Happens if There’s No Deference?
March 04, 2024 15:00 - 28 minutes - 19.7 MBWhat 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 segment...
Artificial Intelligence: Examining Promises, Skepticism, and Ethical Implications
February 19, 2024 16:00 - 30 minutes - 21.2 MBThe 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 developme...
What’s the Score with Your Physicians? Don’t Miss MIPS
February 13, 2024 15:00 - 30 minutes - 20.6 MBThe 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 downwar...
How CERT Data Is Used to Target Providers
February 05, 2024 18:00 - 30 minutes - 21.3 MBAuditors 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 impr...
How to Protect Your Facility from CERT Audits
January 29, 2024 19:00 - 32 minutes - 22.5 MBWhat’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 Fra...
U.S. Forced to Comply with International Healthcare Law: Fact or Fiction?
January 22, 2024 16:00 - 30 minutes - 21 MBWill 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. R...
Look Out, Look Ahead
January 08, 2024 19:00 - 55 minutes - 38.3 MBNo 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 audi...
2023 Healthcare Heroes to be Revealed
December 04, 2023 18:00 - 29 minutes - 20.6 MB“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...
America’s Healthcare System: A Gordian Knot
November 27, 2023 17:00 - 28 minutes - 19.3 MBRACmonitor 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 Monday...
At the Intersection of AI and Medical Record Audits
November 20, 2023 18:00 - 30 minutes - 20.8 MBThe 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 Rame...
False Claims Act Roundup: 2023 Was a Very Good Year for the Feds
November 13, 2023 22:00 - 28 minutes - 19.5 MBTo 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 judgmen...
The Two-Midnight Rule Remains Too Confounding
November 06, 2023 16:00 - 31 minutes - 21.5 MBThe 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, physici...
Violence in America’s Hospitals
October 30, 2023 16:00 - 26 minutes - 18.1 MBViolence 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 Denn...
Lowering Prices, Increasing Supplies of Prescription Drugs
October 23, 2023 18:00 - 28 minutes - 19.7 MBCongress 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 Maur...
When it Rains, it Pours: Understanding New Compliance Risks
October 16, 2023 15:00 - 28 minutes - 19.8 MBSo 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, wi...
The Future of Cancer Treatment is Now: But Will Payers Pay?
October 09, 2023 17:00 - 27 minutes - 18.9 MBCoinciding 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 b...
Does the Two-Midnight Rule Apply to MA Plans?
October 02, 2023 16:00 - 29 minutes - 20.1 MBThe 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, De...
Peeking Behind the Curtain: AI and Claims Auditing
September 25, 2023 16:00 - 30 minutes - 20.8 MBIt’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 fo...
The Medicare Report Card: Assessing Areas for Major Reform
September 18, 2023 17:00 - 30 minutes - 21.2 MBThe United States spends more money on healthcare than any other country in the world. In 2021, U.S. healthcare spending reached $4.3 trillion. Medicare, which insures seniors, is America’s largest national health program, and therefore, it can and should be compared to its counterpart in other countries. So, how does the United States stack up? How do outcomes in the United States compare for patients, and what kind of comparisons can we make from the point of view of the healthcare provi...
Like Autumn Leaves, RAC Audits Keep Falling
September 11, 2023 17:00 - 29 minutes - 20.5 MBThe fall season is just about here. Colorful autumn leaves will be becoming ubiquitous, like claims denials and audits. And in this season, now is the time to “git ‘er done.” And Monitor Mondays is the place to do it. In preparation, following the long Labor Day weekend, RACmonitor producers of Monitor Mondays have enlisted the services of some of the most trusted and respected names in regulatory compliance and claims auditing. And joining this panel of experts in the long-running Interne...
Assessing the Impact of Financial Woes Facing America’s Healthcare Providers
August 28, 2023 16:00 - 31 minutes - 21.4 MBFirst there was COVID-19, which seemed to have torn a gaping hole in our nation’s patchwork quilt of care facilities. Add to this the rising costs of everything that touches healthcare, and now the growing list of Chapter 11 bankruptcies rippling through nursing homes and other facilities that provide care for America’s seniors. But will the tentacles of this lengthening financial crisis reach down and strike at other similar facilities? Reporting our lead story during the next live edition...
Physician Advisors: Revenue Drag or Stimulant?
August 21, 2023 17:00 - 28 minutes - 19.4 MBBroadcast segments will also 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 David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.
What’s So Smart About Smart Hospitals?
August 14, 2023 20:00 - 31 minutes - 21.4 MBInformation technology has revolutionized many industries, including healthcare. “Smart” hospitals promise vast increases in productivity, and are being designed as integrated IT platforms linking together technology, patients, and providers in a complex web of interaction. But are the promised advantages of smart hospitals tangible, or are there a number of factors that may inhibit providers from obtaining the benefits that are promised? And how are things really measured? Edward M. Roche ...
FY 2024 IPPS Final Rule: Looking Under the Hood for Hazards
August 07, 2023 17:00 - 29 minutes - 20.4 MBThe Centers for Medicare & Medicaid Services (CMS) FY2024 Inpatient Prospective Payment System (IPPS) Final Rule, posted on Aug. 1, reveals changes to the MS-DRG, CMS Hospital Acquired Conditions, and CMS Inpatient Quality Reporting Program affecting inpatient revenue cycles, quality reporting, and reputations essential to hospital operations. There are plenty of audit hazards. And that’s why RACmonitor invited James S. Kennedy, MD, a nationally recognized clinical coding authority, to be ou...
Proposed Expansion of Medicaid RACs Includes Focus on Managed Care Payments
July 31, 2023 17:00 - 31 minutes - 21.4 MBThe Government Accountability Office (GAO) is recommending expansion of the Medicaid Recovery Audit Contractors (RACs) program, to include auditing of payments made to managed care organizations (MCOs), according to a GAO report released in June. Launched in 2011 as a consequence of the Patient Protection and Affordable Care Act (PPACA) by the Centers for Medicare & Medicaid Services (CMS), the Medicaid RACs were purported to be aggressive in their recouping of alleged Medicare Fee-for-Serv...
New Developments for Defeating Statistical Extrapolations Revealed
July 25, 2023 15:00 - 29 minutes - 20 MBThere is a buzz swirling within the healthcare auditing community. And thanks to RACmonitor investigative reporter Edward M. Roche, the news is buzzworthy. According to Roche, a legal team has developed two arguments that can be used by healthcare providers in federal court after the Administrative Law Judge (ALJ) process is completed. One argument is based on constitutional rights, while the other is a contradiction between the Medicare Program Integrity Manual and adopted federal law. Du...
$9 Billion Refund to 340B Hospitals at Risk
July 17, 2023 17:00 - 31 minutes - 21.3 MBThe Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to remedy Medicare Part B pay cuts made to 340B hospitals by issuing a lump-sum repayment to affected facilities. Last year, the U.S. Supreme Court ruled that those cuts, implemented by CMS from 2018 through most of 2022, were unlawful. Consequently, CMS proposed to offset the refunds by reducing payments for non-drug services to all hospitals under the 2024 Outpatient Prospective Payment System (OPPS). Commenting...
Enforcement and Penalties, Guardrails and Risks: Understanding the 21st Century Cures Act
July 10, 2023 17:00 - 30 minutes - 21 MBAlthough the 21st Century Cures Act was enacted in 2016, many hospitals today continue to struggle with effective implementation of its provisions and the goal of preserving patient access to medical records. Seven years later, however, meaningful guidance regarding its enforcement is here. One of the provisions requires developers not to engage in information blocking. Now that the guardrails are in place and the risks have been identified, Monitor Monday’s own physician and attorney Dr. ...
The Big Worry. The Big Unwind: Medicaid Disenrollment Keeps Rolling Along
June 26, 2023 18:00 - 29 minutes - 20.4 MBAt least 1.3 million Medicaid enrollees have been disenrolled as of June 20, according to the Kaiser Family Foudation (KFF) “Unwinding Tracker.” This estimate could be an under-count, KFF admits, due to state recordkeeping details. Yet the major issue looms on the horizon: what will happen to those who have lost their Medicaid benefits? Could a tsuansmi of patients without health insurance soon appear at your hospital? During the next live edition of Monitor Mondays, Tony DiLuca, principal ...
How Suffocating Regulations Are Leading to Smart Hospitals
June 19, 2023 16:00 - 30 minutes - 21 MB“Hospitals may be the most complex organizations in the world,” writes Edward M. Roche, scholar, United Nations consultant, and RACmonitor investigative reporter. “They are tasked with improving patient outcomes, controlling costs, and meeting sustainable environmental goals.” Roche, who will be the featured panelist during the next live edition of Monitor Mondays, believes that hospitals, in their quest for stability, have been nonetheless traumatized by the COVID-19 epidemic and a suffoca...
How Staffing Shortages Increase Audits
June 12, 2023 17:00 - 30 minutes - 20.8 MBHealthcare organizations often face staffing shortages in their revenue cycle, adding to the pressure of ensuring proper claims processing. The Centers for Medicare & Medicaid Services (CMS), U.S. Department of Justice (DOJ), and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) have increased audits to reduce improper payments, using predictive modeling and artificial-intelligence (AI) tools. Risk-based audits rose by 28 percent and prospective audits by 3...
Running Afoul of Federal Regulations
June 05, 2023 17:00 - 28 minutes - 19.7 MBThis week, a disgraced Elizabeth Holmes was seen in media clips walking in the company of two unidentified men. Evidently, Holmes, who was convicted of fraud for her blood-testing start up, Theranos, turned herself in at a minimum-security prison in Texas to begin an 11-year prison term. All this media coverage raises the question: how easy is it to run afoul of the government regarding a wide range of statutes and regulations? Moreover, how far do you have to go to actually get to prison?...
Smart Strategies to Avoid Denials of SNF Transfers
May 22, 2023 18:00 - 31 minutes - 21.6 MBWhy the confusion and the apparent uptick in denials by Managed Care Organizations (MCOs) for skilled nursing facility (SNF) transfers? Returning to report on this vexing topic during the next live edition of Monitor Mondays will be Ben Kartchner, MD, a physician advisor who will join the broadcast to present the final installment in his two-part series being produced by RACmonitor and Monitor Mondays. Dr. Kartchner will be adapting his recent presentation to the American College of Physic...
How to Avoid Managed Care Denials for SNF Transfers
May 15, 2023 16:00 - 30 minutes - 20.8 MBMedical necessity denials for skilled nursing facility (SNF) transfers by Managed Care Organizations (MCOs) are increasing at an astonishing rate. The reason seems to be a lack of understanding of the difference between skilled and non-skilled care. During an exclusive two-part series being produced by RACmonitor and Monitor Mondays, Ben Kartchner, MD will delve into this complex topic that is generating buzz, especially among physician advisors, many of whom appear to be struggling with po...
Compliance Risk and Revenue Loss: Practicing without Privileges
May 08, 2023 17:00 - 28 minutes - 19.5 MBYour medical staff office just notified you that a physician has been performing procedures without privileges for the past five years. No, it doesn’t happen all the time. But what should you do? Physician and attorney Dr. John K. Hall will walk you through the considerations and help you understand how much revenue might be in jeopardy during the next live edition of Monitor Mondays. Broadcast segments will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch...
Utilization and Billing: Reconciling Conflicts
May 01, 2023 17:00 - 30 minutes - 20.8 MBHospital utilization and billing are notoriously challenging concepts for providers and case management staff because they frequently boil down to two, often conflicting points of view: what can be done per the rules, regulations, and contracts, and what should be done to provide the most effective care for a patient? In a world where process standardization is imperative to maintain health system viability, but also where the practice of medicine remains an art, teams need a broad understa...
The False Claims Act: Will it Live to See Another Day?
April 24, 2023 17:00 - 28 minutes - 19.7 MBThe beleaguered False Claims Act, which traces its origins to the Civil War, came before the Supreme Court this past Tuesday, when the Court heard oral arguments in a consequential and closely watched case involving one of the Government’s most effective tools for fighting healthcare fraud. Specifically, the issue is whether and when a defendant’s contemporaneous subjective understanding or beliefs about the lawfulness of its conduct are relevant to whether it knowingly violated the Act. T...
Confronting Artificial Intelligence: Healthcare’s Next Major Disruptor
April 17, 2023 16:00 - 30 minutes - 21.2 MBRecent highly publicized advances in artificial intelligence forecast the elimination of at least 30 percent of the healthcare workforce (probably more), including all generalist physicians. The astonishing scalability of information technology suggests that one to three data centers will be able to deliver medical advisory services to the entire population of the United States, according to Edward M. Roche, who will be reporting our lead story during the next live edition of Monitor Mondays...
The Ins and Outs of Procedures: Confronting the CMS Inpatient-Only List
April 10, 2023 18:00 - 25 minutes - 17.9 MBThis year, as in past years, the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only List continues to confuse and bewilder so many healthcare professionals. And it’s little wonder: in 2021, CMS removed 500 surgical procedures from the List, only to reinstate most but not all of the procedures for 2022. Today, most Medicare and Medicaid plans follow the CMS Inpatient-Only List. But not all. Join us this coming Monday when Mary Beth Pace, our special guest on the next edition of Mo...
Reintroducing the Three-Midnight Rule: It’s Back, and it’s a Problem
April 03, 2023 17:00 - 27 minutes - 19.2 MBIt’s back: the Three-Midnight Rule. Created with the nation’s 1965 enactment of Medicare, the Rule provided that patients needed to have at least three consecutive midnights of inpatient care in an acute hospital setting before being admitted to skilled nursing facility (SNF). And then came the COVID-19 pandemic and the federal Public Health Emergency (PHE), and the rule was waived. Now, as the PHE is about to expire on May 11, the Rule is making a comeback. And that could pose problems fo...
15 Million Enrollees Soon to be Missing: The Unwinding of Medicaid’s Continuous Enrollment
March 27, 2023 16:00 - 32 minutes - 22.3 MBIt’s the biggest healthcare story of the decade: up to 15 million individuals will soon be disenrolled from Medicaid, when the COVID-19 public health emergency (PHE) shuts down. Those who enrolled in Medicaid during the pandemic must re-enroll to keep their Medicaid coverage. Suddenly, your hospital could be overrun with uninsured patients. What’s being done about this issue, and what can you do? Join us during the next live edition of Monitor Mondays, when Dennis Jones will be reporting o...
Reverse False Claims: This Could Happen to You
March 20, 2023 19:00 - 30 minutes - 21.1 MBImagine for a moment that the federal government, through one of its contractors, sends you money for services you don’t believe are covered benefits for a particular patient at your facility. But wait. Don’t react just yet. The best course of action might not be what you think, and it’s definitely not simple or straightforward, as you’ll learn during the next live edition of the long-running Monitor Mondays Internet radio broadcast. That’s when physician and attorney Dr. John K. Hall will...