“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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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 much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

The 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 provider? Do doctors have it better in the United States, or in other places? What lessons can we learn? Where are the most urgent areas that need reform?During the next live edition of Monitor Mondays, RACmonitor investigative reporter Edward M. Roche will examine U.S. healthcare in comparison with that of other countries, focusing on a number of dimensions, including cost, quality, outcomes, and ease of use.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 David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Lead Story: RACmonitor investigative reporter Edward M. Roche will report the lead story on the performance scorecard for Medicare.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

The 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 Internet broadcast will be a new voice added to the lineup: Angela Jordan, currently executive vice president of Calm Waters AI, Inc., specialists in evaluation and management (E&M) leveling services.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 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 that will impact the healthcare regulatory setting.E&M Update: Angela Jordan, executive vice president for Calm Waters AI, Inc., will report on the latest twists and turns associated with the omnipresent E&M services impacting physicians and physician groups.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

First 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 or Monitor Mondays will be William Dombi, president and CEO for the National Association for Home Care and Hospice.Broadcast 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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

Broadcast 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.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

Information 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 will discuss this high-growth area of expenditures, and go over both the accelerators and inhibitors of this transformation in healthcare. Broadcast 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.Legislative Update: Cate Brantley,  legislative analyst for Zelis, will report on current healthcare legislation.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

The 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 our expert tour guide during the next live edition of Monitor Mondays to identify potential risks and opportunities effective on October 1, 2023.  Broadcast 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 Cara Ludwig, substituting for 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, a legislative analyst for Zelis, will report on current healthcare legislation.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

The 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-Service (FFS) overpayments. They could now be poised to expand into the rapidly growing MCO plans.  During the next live edition of Monitor Mondays, Dennis R. Jones, senior director of revenue cycle at Jefferson Health, will report on this developing story.Broadcast 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, partner at the law firm of Nelson Mullen, 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 current healthcare legislation.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

There 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.During the next live edition of Monitor Mondays, Mr. Roche will discuss these two arguments briefly, and issue a call for providers who are at this stage in their appeals and might be interested in someone taking up their case on a contingency basis. Broadcast 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, 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 affairs analysis for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify

The 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 on this latest development impacting 340B hospitals during the next edition of Monitor Mondays will be the president and CEO for 340B Health, Maureen Testoni.Broadcast 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, 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 analysis for Zelis, will report on current healthcare legislation.The Wrapper: John Zelem, founder and CEO of Streamline Consulting Solutions, will join the broadcast for a wrap-up on the morning’s top stories.& so much moreA bi-monthly podcast where we share the stories of our Caregivers, patients and...Listen on: Apple Podcasts   Spotify