Monitor Mondays

Apr 22 2024 122
Monitor Mondays Podcast artwork

Join 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/

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The Two-Midnight Rule: Navigating Treacherous Medicare Currents

Apr 22 2024 27 mins  
Like 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 o

Defense Strategies Against AI Audits

Apr 15 2024 40 mins  
Artificial 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

Medicare Advantage “Schemes” in the DOJ Crosshairs

Apr 08 2024 31 mins  
The 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 chal

Whistleblower Update: $300 Million in Alleged Fraud

Apr 01 2024 31 mins  
The 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 mili

How to Achieve a Clear Vision for Hospital Price Transparency

Mar 25 2024 29 mins  
Since 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 executive

The Fix is in: Hospital Price Transparency Rule

Mar 18 2024 28 mins  
Many 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

Empowering the Bedside Physician to Lower Observation Rates

Mar 11 2024 30 mins  
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

Hospital Price Transparency Rule: An Important Update

Mar 04 2024 28 mins  
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 202

Updated Episode | Chevron Deference: What Happens if There’s No Deference?

Mar 04 2024 28 mins  
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 ramificati

Artificial Intelligence: Examining Promises, Skepticism, and Ethical Implications

Feb 19 2024 30 mins  
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 f