Monitor Mondays

Nov 18 2024 333 ep. 30 mins 128
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/

  Education  Government  Health & Fitness
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New Healthcare Survey Reveals Need for Continuous Financial Risk Monitoring

Nov 18 2024 29 mins  
As we continue to monitor and review the latest healthcare news, we are always pleased when word of a new study comes to our attention – especially when the study is within the purview of MDaudit.During the next live edition of Monitor Mondays, the CEO for MDaudit, Ritesh Ramesh, will report the latest results of a new national study – and how the salient takeaway points could

Simplifying the Two-Midnight Rule: Simple as 1, 2, 3

Nov 11 2024 30 mins  
Long a contentious edict from the Centers for Medicare & Medicaid Services (CMS), the Medicare Two-Midnight Rule can be simplified into three basic elements.For the first time, Monitor Mondays, along with esteemed physician advisor Benjamin Kartchner, will be outlining them, along with all that’s needed to undo the gordian knot of denials.During the next live edition of the v

Denials Going from Bad to Worse

Nov 04 2024 28 mins  
Denials in healthcare are a problem.Recently, though, the problem seems to be getting worse, especially with the misapplication of the Two-Midnight Rule by Medicare Advantage (MA) plans, according to Nick Hut, senior editor for Healthcare Financial Management Association (HFMA).Hut reports that MA plans are classifying hospital stays as outpatient observation visits at a significan

Sex, Lies and Turmoil

Oct 28 2024 27 mins  
A pediatrician under investigation related to accusations that she had engaged in sexual relations with a male patient, having lied about it when applying for another healthcare position, was recently sentenced for making false statements.In another case, a federal contractor agreed to resolve False Claims Act allegations in connection with a government contract related to its stor

The Two-Midnight Rule: Presumption of Risk

Oct 21 2024 26 mins  
Could you and your care team be at risk when you upgrade a patient from observation to inpatient simply because the patient passed a second midnight in the hospital, based on the Centers for Medicare & Medicaid Services (CMS) contentious Two-Midnight Rule?And what about the expectation? How does expectation enter this equation? And finally, what should be present to change that

False Claims Act Violation: Unnecessary Drug Testing Flags Feds

Oct 14 2024 26 mins  
The U.S. Department of Justice (DOJ) has reported that one of America’s largest urine drug-testing companies has agreed to pay $27 million to resolve allegations of unnecessary drug testing and illegal remuneration to physicians.The False Claims Act allegations resolved by this settlement were originally brought in three lawsuits filed by whistleblowers under the qui tam provisio

340B Drug Rebates: Old Debate Revived, But Shot Down

Oct 07 2024 27 mins  
A major drug company’s attempt to turn 340B drug pricing program discounts into rebates made big headlines in recent weeks. Maureen Testoni, president and CEO of 340B Health, will review how this potentially major upheaval came about, how 340B stakeholders responded, and how the drugmaker backed off after the federal government threatened it with massive penalties.This debate is

Violence in America’s Hospitals

Sep 30 2024 28 mins  
As violent crime has trended slightly downward throughout the United States over the last year, a wound to this country’s collective psyche that appears reluctant to close is workplace violence in America’s hospitals.Reporting the lead story during the next live edition of Monitor Mondays will be special assignment contributor Dennis Jones, senior director of revenue cycle at J

Whistleblower Report: Oak Street Health Agrees to Pay $60M to Resolve Alleged False Claims Act Liability in Medicare Advantage Patient Recruitment Scheme

Sep 26 2024 28 mins  
Oak Street Health, headquartered in Chicago and a wholly-owned subsidiary of CVS Health since 2023, has agreed to pay $60 million to resolve allegations that it violated the False Claims Act by paying kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street Health’s primary care clinics, according to a news release issued by the U.S. Department o

Exposing Challenges to Getting Paid by Medicare Advantage

Sep 16 2024 29 mins  
You need to get paid properly for surgical procedures on the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only (IPO) List, according to Mary Beth Pace, vice president of care management at Trinity Health, and also the special guest during the next live edition of Monitor Mondays.Pace, in making the statement, was referring to rules and regulations set forth in the F