Latest Racs 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...
Guest Episode on Chest Trauma with James McKay
First Incision - April 02, 2024 07:00 - 38 minutesThis episode covers the topic of chest trauma, with the James Mckay, an incredible general surgeon, trauma surgeon, and dual trained intensive care physician. Topics covered include: - rib fractures - flail chest - blunt cardiac injury - chest drains - resuscitative thoracotomy And more! 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...
Guest Episode on Familial Cancer Syndromes with Chris Wakeman
First Incision - March 07, 2024 06:00 - 33 minutesThis guest episode with colorectal surgeon Chris Wakeman focuses on the common familial cancer syndromes. For each we go through diagnosis, genetics, surveillance, management, decision making and more. Topics include: - Familial Adenomatous Polyposis (FAP) - Lynch Syndrome - Serrated Polyposis S...
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...
Guest Episode on Malignant Colorectal Polyps with Henry Drysdale
First Incision - February 21, 2024 23:00 - 38 minutesThis episode is the first part of a series that has been produced in collaboration with the Australian and New Zealand Training Board in Colon and Rectal Surgery (ANZTBCRS). It has come out of work prepared for the Colorectal Fellow's Training Weekend held in Adelaide in August 2023. Henry Dry...
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...
Guest Episode on Total Neoadjuvant Therapy (TNT) for Rectal Cancer with Simon Richards
First Incision - February 15, 2024 12:00 - 44 minutesFor this guest episode we are joined by Dr Simon Richards, as colorectal surgeon from Christchurch New Zealand. This episode is a masterclass in Total Neoadjuvant Therapy (TNT) for Rectal Cancer. We cover: - the traditional paradigm of rectal cancer management and how it's progressed to where w...
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...
Guest Episode on Bariatric Surgery with Carla Gillespie
First Incision - February 07, 2024 07:00 - 48 minutesOn this guest episode we are joined by Dr Carla Gillespie, an UGI, bariatric and general surgeon from Sydney to cover the topic of bariatric surgery. We cover: - pathophysiology - types of operations - considerations when deciding what operation - complications - immediate and late - how to rem...
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 ...
Intestinal Failure
First Incision - January 22, 2024 06:00 - 29 minutesFrom the vault (courtesy of Tara who found it). This episode covers the topic of intestinal failure. It includes: - definition - classification - pathophysiology - prevention - the three phases - intestinal adaptation - management - complications (short and long term) Disclaimer The informatio...
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...
Guest Episode on Fellowship with Ashwini Pondicherry and Jamie Crichton
First Incision - December 23, 2023 20:00 - 59 minutesIn this week's 'Christmas Special' episode I am joined by Ashwini Pondicherry and Jamie Crichton to reflect on our first year of fellowship. We discuss some of the good things about this transition, but also some of the more difficult and formative aspects and how we negotiated them. The step fr...
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...
Breast Cancer Cases - Guest Episode with Ashwini Pondicherry
First Incision - November 22, 2023 07:00 - 45 minutesOur first episode back (in a while - sorry!) is an incredible guest episode that is worth the wait. We talk through a series of breast cancer cases with Ashwini Pondicherry, the current breast fellow at Christchurch hospital, to cover a wide range of topics in breast cancer. This includes some ...
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...
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