Shows
Enter the DangerBeth Fredrickson - Executive Director of HarborPoint Ministries and Owner of JustWrite CommunicationThis month I'm joined by Beth Fredrickson, Executive Director of Harbor Point Ministries. Beth has been leading the organization for eight years.The Non-Anxious leader: https://thenonanxiousleader.com/2024-10-3042 min
Monitor MondaysExposing Challenges to Getting Paid by Medicare AdvantageYou 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 Federal Register for Medicare in 2024. She also alleges that some Medicare Advantage (MA) plans are not abiding by some of those rules and regulations. Pace says all MA plans need to abide by the IPO and...2024-09-1629 minMonitor MondaysHandle with Care: Taking Steps for Safe TransitionsHave you ever wondered how professional movers carefully pack everything? From expensive china to precious crystal stemware, they seem to have a knack and knowledge for how to prepare.When it comes to healthcare, how safe is the transition from hospital to home if a patient cannot get the services they need at home when they are ready to transition?More and more, we are seeing challenges with home health care agencies not being available for our patients who need home care at discharge, according to Mary Beth Pace, vice president of care management at...2024-07-1529 minMonitor MondaysSmart Strategies to Avoid Denials of SNF TransfersWhy the confusion and the apparent uptick in denials by Managed Care Organizations (MCOs) for skilled nursing facility (SNF) transfers?Returning to report on this vexing topic during the next live edition of Monitor Mondays will be Ben Kartchner, MD, a physician advisor who will join the broadcast to present the final installment in his two-part series being produced by RACmonitor and Monitor Mondays.Dr. Kartchner will be adapting his recent presentation to the American College of Physician Advisors, exclusively for Monitor Mondays and RACmonitor. You will learn how to effectively counter MCO denials with...2023-05-2231 minMonitor MondaysThe Ins and Outs of Procedures: Confronting the CMS Inpatient-Only ListThis year, as in past years, the Centers for Medicare & Medicaid Services (CMS) Inpatient-Only List continues to confuse and bewilder so many healthcare professionals. And it’s little wonder: in 2021, CMS removed 500 surgical procedures from the List, only to reinstate most but not all of the procedures for 2022. Today, most Medicare and Medicaid plans follow the CMS Inpatient-Only List. But not all.Join us this coming Monday when Mary Beth Pace, our special guest on the next edition of Monitor Mondays, will serve as our guide, helping you avoid auditing pitfalls while traversing this tricky compliance territory of...2023-04-1025 minMonitor MondaysAudit Roundup: Broadcast 5002010 does not seem that long ago. It’s hard to believe we’re at Monitor Mondays broadcast No. 500 since then.But then again, let’s look at all we’ve seen change. Medicare started out with a one-midnight expectation for inpatient reimbursement. Then the Recovery Audit Contractors (RACs) moved in, showed us all the errors of our ways, and demonstrated that unrestrained denials could overwhelm the appeal system.Then we got the two-midnight rule, which, oddly enough, seemed to make sense. It carved off a bunch of inpatient stays, but also curtailed denials. Then we saw the...2022-05-0929 minMonitor MondaysLearn How to Relieve the Stress: Observation Volumes Plaguing HospitalsHow is one major hospital system reducing observation hours?Listen to the next live edition of Monitor Mondays to find out; that’s when Mary Beth Pace will return, by popular demand, to continue her compelling discussion on how she and her team at Trinity Health are taking steps to reduce the volume of observation hours. With her laser focus on patient care, Pace will report on how the Centers for Medicare & Medicaid Services (CMS) two-midnight rule, implemented in October 2013, continues to be misinterpreted by some insurance companies to their advantage, further obfuscating patient status determination....2022-04-1830 minMonitor MondaysObservation Volumes Continue to Stress HospitalsWhat are your observation volumes doing to your bottom line? How much care do these patients get compared to your inpatients?If your facility is like most facilities, the billing status does not dictate the care provided; it just dictates the reimbursement you can expect to obtain. Worse yet, it does not leverage the patient’s insurance benefits correctly. Join us during the next live edition of Monitor Mondays as Mary Beth Pace reports on what should and could be done with the insurance companies that are dictating billing status, no matter the care provided to...2022-04-1131 minMonitor MondaysDrug Manufacturers Imposing Unlawful Limits on 340B DiscountsA growing number of drug manufacturers are imposing unlawful limits on 340B discounts, according to a newly released report by 340B Health. Currently, up to 13 such companies “just say no” to discounts for prescription drugs sold to safety-net hospitals and dispensed through community pharmacies.During the next live edition of Monitor Mondays, reporting on the findings of this new report released late last month will be Maureen Testoni, president and CEO for 340B Health. Testoni is expected to report on how these major manufacturers are having a deleterious impact on 340B hospitals, while at the same time poss...2022-02-1429 minMonitor MondaysThe Dilemma of Sepsis ReportingControversy swirls and denials of claims continue when it comes to reporting sepsis. Exacerbating this compliance issue is the dual definition of the condition: The Centers for Medicare & Medicaid Services (CMS) and in many cases, payers use the Sepsis 2 definition, while generally, providers rely on Sepsis 3.Joining us on this episode of Monitor Mondays, Mary Beth Pace, vice president of care management at Trinity Health, will share how her system approaches the dilemma of sepsis.The broadcast rundown also will include:Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory...2018-12-1031 minMonitor MondaysTotal Knee or Total Consternation?Should total knee replacements (TKRs) be performed as inpatient or outpatient procedures? Some facilities are admitting all of them as inpatient while other facilities take a more conservative approach to admission. How are TKRs being handled at your facility?
Mary Beth Pace, vice president of care management at Trinity Health and the special guest on this edition of Monitor Mondays, frames the conundrum as a hypothetical patient/caregiver conversation: "we are going to do major surgery on you, but we are not sure if we will keep you after surgery – and oh, by the way, there will be...2018-02-1930 min