Latest Oig Podcast Episodes
The Two-Midnight Rule: Navigating Treacherous Medicare Currents
Monitor Mondays - April 22, 2024 17:00 - 27 minutes ★★★★ - 19 ratingsLike 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...
Defense Strategies Against AI Audits
Monitor Mondays - April 15, 2024 16:00 - 40 minutes ★★★★ - 19 ratingsArtificial 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 inade...
Medicare Advantage “Schemes” in the DOJ Crosshairs
Monitor Mondays - April 08, 2024 15:00 - 31 minutes ★★★★ - 19 ratingsThe 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. D...
Whistleblower Update: $300 Million in Alleged Fraud
Monitor Mondays - April 01, 2024 16:00 - 31 minutes ★★★★ - 19 ratingsThe 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...
How to Achieve a Clear Vision for Hospital Price Transparency
Monitor Mondays - March 25, 2024 16:00 - 29 minutes ★★★★ - 19 ratingsSince 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 Fix is in: Hospital Price Transparency Rule
Monitor Mondays - March 18, 2024 19:00 - 28 minutes ★★★★ - 19 ratingsMany 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-...
Empowering the Bedside Physician to Lower Observation Rates
Monitor Mondays - March 11, 2024 18:00 - 30 minutes ★★★★ - 19 ratingsAmerica’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 admiss...
Hospital Price Transparency Rule: An Important Update
Monitor Mondays - March 04, 2024 17:00 - 28 minutes ★★★★ - 19 ratingsThere 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 bi...
Updated Episode | Chevron Deference: What Happens if There’s No Deference?
Monitor Mondays - March 04, 2024 15:00 - 28 minutes ★★★★ - 19 ratingsWhat 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 Monda...
Artificial Intelligence: Examining Promises, Skepticism, and Ethical Implications
Monitor Mondays - February 19, 2024 16:00 - 30 minutes ★★★★ - 19 ratingsThe 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...
What’s the Score with Your Physicians? Don’t Miss MIPS
Monitor Mondays - February 13, 2024 15:00 - 30 minutes ★★★★ - 19 ratingsThe 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-run...
How CERT Data Is Used to Target Providers
Monitor Mondays - February 05, 2024 18:00 - 30 minutes ★★★★ - 19 ratingsAuditors 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, i...
How to Protect Your Facility from CERT Audits
Monitor Mondays - January 29, 2024 19:00 - 32 minutes ★★★★ - 19 ratingsWhat’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 po...
U.S. Forced to Comply with International Healthcare Law: Fact or Fiction?
Monitor Mondays - January 22, 2024 16:00 - 30 minutes ★★★★ - 19 ratingsWill 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 ...
Look Out, Look Ahead
Monitor Mondays - January 08, 2024 19:00 - 55 minutes ★★★★ - 19 ratingsNo 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 inconsistenc...
2023 Healthcare Heroes to be Revealed
Monitor Mondays - December 04, 2023 18:00 - 29 minutes ★★★★ - 19 ratings“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...
America’s Healthcare System: A Gordian Knot
Monitor Mondays - November 27, 2023 17:00 - 28 minutes ★★★★ - 19 ratingsRACmonitor 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 o...
At the Intersection of AI and Medical Record Audits
Monitor Mondays - November 20, 2023 18:00 - 30 minutes ★★★★ - 19 ratingsThe 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 ...
False Claims Act Roundup: 2023 Was a Very Good Year for the Feds
Monitor Mondays - November 13, 2023 22:00 - 28 minutes ★★★★ - 19 ratingsTo 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 ...
The Two-Midnight Rule Remains Too Confounding
Monitor Mondays - November 06, 2023 16:00 - 31 minutes ★★★★ - 19 ratingsThe 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 importa...
Violence in America’s Hospitals
Monitor Mondays - October 30, 2023 16:00 - 26 minutes ★★★★ - 19 ratingsViolence 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...
Lowering Prices, Increasing Supplies of Prescription Drugs
Monitor Mondays - October 23, 2023 18:00 - 28 minutes ★★★★ - 19 ratingsCongress 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 im...
When it Rains, it Pours: Understanding New Compliance Risks
Monitor Mondays - October 16, 2023 15:00 - 28 minutes ★★★★ - 19 ratingsSo 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 convicti...
The Future of Cancer Treatment is Now: But Will Payers Pay?
Monitor Mondays - October 09, 2023 17:00 - 27 minutes ★★★★ - 19 ratingsCoinciding 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 intr...
Does the Two-Midnight Rule Apply to MA Plans?
Monitor Mondays - October 02, 2023 16:00 - 29 minutes ★★★★ - 19 ratingsThe 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 t...
Peeking Behind the Curtain: AI and Claims Auditing
Monitor Mondays - September 25, 2023 16:00 - 30 minutes ★★★★ - 19 ratingsIt’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 ...
The Medicare Report Card: Assessing Areas for Major Reform
Monitor Mondays - September 18, 2023 17:00 - 30 minutes ★★★★ - 19 ratingsThe 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...
Like Autumn Leaves, RAC Audits Keep Falling
Monitor Mondays - September 11, 2023 17:00 - 29 minutes ★★★★ - 19 ratingsThe 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 o...
Assessing the Impact of Financial Woes Facing America’s Healthcare Providers
Monitor Mondays - August 28, 2023 16:00 - 31 minutes ★★★★ - 19 ratingsFirst 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 p...
Physician Advisors: Revenue Drag or Stimulant?
Monitor Mondays - August 21, 2023 17:00 - 28 minutes ★★★★ - 19 ratingsBroadcast 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 ...
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