Shows
Monitor MondaysMay I have the Envelope: 2024 Healthcare Heroes to be Revealed“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.Other broadcast segments will include these instantl...2024-12-1628 min
Dad to Dad PodcastSFN Dad To Dad 356 - Tieal Bishop of Walkerton, IN Founder Of A Rosie Place For Children & Mother To Six, Including A Medically Fragile Son.Our guest this week is Tieal Bishop, of Walkerton, IN, mother to six including a medical fragile son and founder of A Rosie Place For Children.Tieal and her husband,Travis, have been married for eight years and between them they are the proud parents of six children: Max (25), Sam (22) and Gigi (20) and triplet 21 year old girls, Madeline, Abby and Kate. Her oldest son, Max, had a precarious entry into the world. Diagnosed with RSV, he required a G-Tube for feeding, a Trach for breathing and seven month in the PICU, which resulted in the family sta...2024-12-1359 min
Talk Ten TuesdaysDon’t Code for Panic: Understanding the New Medicare Appeal ProcessThe panic was widespread. Rumors were flying. Cellphone alarms were sounding.From large hospital conference rooms to upholstered cubicles, everyone seemed to have the same sense of disbelief and mounting frustration: Acentra Health (previously Kepro) had announced a new appeal process for Medicare patients – specifically, those whose status changed from inpatient to observation.Among those who maintained a sense of composure was healthcare regulatory guru Ronald Hirsch, MD.Dr. Hirsch, a popular presenter on Monitor Mondays, produced by RACmonitor, carefully read the documents and concluded that while no one in healthcare wanted to be...2024-10-2929 min
How2Exit: Buy, Don't Build - M&A of Small BusinessesE211: Strategic Staffing: Nathan Hirsch's Key to Scaling Businesses through Effective Team BuildingAbout the Guest(s): Nathan Hirsch, a seasoned entrepreneur, excels in online businesses, strategic growth, and operations. Co-founding FreeeUp, a freelancer marketplace successfully exited in 2019, he's adept at acquiring top talent through optimized hiring. His latest ventures include Outsource School, educating on virtual team management, and EcomBalance, offering specialized bookkeeping for e-commerce. With a deep marketing understanding, Hirsch implements organic growth tactics across his ventures.Summary: In this engaging episode, Ronald Skelton chats with Nathan Hirsch, a seasoned entrepreneur specializing in business growth and exits. They explore how Hirsch scaled and sold FreeeUp, offering...2024-05-0854 min
Dad to Dad PodcastSFN Dad To Dad 304 - Dr. Greg Pursley of Jackson, MO A Chiropractor, Author & Father Of Two Including A Son With DwarfismOur guest this week is Dr. Greg Pursley of Jackson, MO who is a chiropractor, owner of PC Medical Centers, father of two and author of two books.Greg and his wife, Sheree, have been married for 19 years and are the proud parents of two children: daughter, Eveekay(18) and son, Izaac(16), who has dwarfism.We’ll hear about the many organizations that have played an influential role in the Pursley family, including:Make A Wish FoundationChallenged Athlete FoundationLittle People of America Dwarf Athletes Association of America, and ...2024-05-0351 min
Bob Dole 1993 - 1995 The Last Man StandingEpisode 258 MAYOR HIRSCH ( Part 5 ) Mayor of Myrtle Beach 1973 - 1977 ( 6 - Part Special Series )Send us a textIn this episode, in our special series, looking at the career of former Mayor Robert Hirsch, we look back at his arrival in Myrtle Beach and his single term as Mayor. It was a term of extraordinary accomplishment, much of which may not be as well known by the public in general today. Myrtle Beach today is the fastest growing region in America, a far cry from where it was in the early 1970s.When Mayor Hirsch was elected in 1973 , the City of Myrtle Beach was operated under an entirely different f...2024-01-311h 04Bob Dole 1993 - 1995 The Last Man StandingEpisode 257 MAYOR HIRSCH ( Special Edition ) Introducing you to Strom Thurmond, Governor Jim Edwards, and General George S. PattonSend us a textIn this special Edition within our special series I thought it was important to introduce you to three of the names you have heard or will hear in our series. As a person in my 50s who has worked in or around politics my entire life these names are familiar to me. That may not be the case for so many of our listeners who are either younger or not from South Carolina. Strom Thurmond, the former Senator from South Carolina, was as dominate a political figure in my home state for...2024-01-3045 minMonitor Mondays2023 Healthcare Heroes to be Revealed“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...2023-12-0429 min
HFMA’s Voices in Healthcare FinanceDr. Ronald Hirsch of R1RCM discusses new Alzheimer's drug Leqembi with HFMA's Nick HutDr. Ronald Hirsch of R1RCM discusses considerations around a new Alzheimer's drug with Senior Editor Nick Hut.Mentioned in this episode:CY 2024 Hospital Outpatient Prospective Payment System (OPPS) Policy Changes: Hospital Price Transparency Proposals (CMS-1786-P) | CMSNCA - Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease (CAG-00431R) - Proposed Decision Memo (cms.gov)2023-07-3116 min
The Doctor’s Crossing Carpe Diem PodcastEpisode #134: Being A Physician Advisor in a Non-Hospital-Based RoleThe physician advisor role is one that can be a bit confusing to understand just from the title alone. Our guest today, Dr. Ron Hirsch, is going to help clarify what physicians advisors do when working in a boots-on-the-ground capacity for a hospital system versus working remotely for a third-party company that provides physician advisory services. Dr. Hirsch will be sharing details about both types of physician advisor roles, with an emphasis on the position at third-party companies, such as R1 RCM where he is Vice President of Physician Advisory Services. Ron will be sharing what the job entails...2023-06-1432 min
Dad to Dad PodcastDad to Dad 240 - Ron Sandison of Rochester Hills, MI, An Autistic Man, Father, Author & Founder Of Spectrum InclusionOur guest this week is Ron Sandison of Rochester Hills, MI who is an Autistic man, a psychiatric care specialist at UHS Havenwyck Hospital, a professor at the Divinity School of Ministry, a speaker, an author of several books, and founder of Spectrum Inclusion, which empowers young adults with Autism for independence and employment through mentoring and conferences.Ron and his wife, Kristen, have been married for 10 years and are the proud parents of Mikayla (6). Ron's books include:A Parent’s Guide to Autism: Practical Advice. Biblical Wisdom.Views from the Spectrum: A Window into Li...2023-02-1042 min
The Podcast by KevinMDImproving the physician-nurse relationship: insider tips from a physician advisorIn this episode, we dive into the physician-nurse relationship and explore the different communication styles and preferences of physicians. Our guest, Ronald Hirsch, is a medical director for case management at a community hospital and shares his insights as a physician on things that nurses should know when communicating with doctors. From tips on writing narrative notes to understanding the pressures and workloads of physicians, this episode is for anyone working in the health care field. Join us for an honest and informative conversation on improving the physician-nurse relationship. Ronald Hirsch is an internal medicine physician and...2023-02-0515 min
In These Times with Rabbi Ammi HirschRonald S. LauderA successful businessman, a generous philanthropist and one of the Jewish world's most important leaders, Ronald S. Lauder wasn't involved in Jewish life until his experience as ambassador to post-war Austria changed him.Support this podcast at — https://redcircle.com/in-these-times-with-rabbi-ammi-hirsch/donations2023-01-0530 min
Talk2MeDoc with Andrew TisserWhat is a Physician Advisor? Learn All About This Fantastic Career with Dr. Ronald Hirsch!Join Dr. Andrew Tisser and guest Dr. Ronald Hirsch as they discuss what a Physician advisor is, its duties and responsibilities, and why it is an essential role in the hospital. Dr. Hirsch shares that a physician advisor determines the correct admission status for the patient so that the hospital gets paid for the care, the physicians get paid for the care, and the patients are in the correct status. From that, it grew into involving a whole bunch of other things. One of the most significant duties now with physician advisors is to work with the Clinical Documentation...2023-01-0429 minMonitor MondaysToo Big to Fail: Part IIIn October, after 18 months in the news cycle, Optum closed its controversial acquisition of Change Healthcare. While the healthcare industry intensely watched the merger beat a challenge from the U.S. Department of Justice (DOJ) on antitrust grounds, that news story was far from the only newsworthy acquisition that Optum has made. With far less public discourse than the Change Healthcare acquisition, Optum has made 18 acquisitions and six investments in recent years. The company has spent more than $30 billion on acquisitions in multiple sectors. Simply stated, Optum is embedded in every nook and cranny of healthcare and is t...2022-12-1231 min
Dad to Dad PodcastDad to Dad 222 - Christian Sakamoto of Ocean Shores, WA A Financial Planner & Father Of Three, Including One With Infantile SpasmsOur guest this week is Christian Sakamoto of Ocean Shores, WA, a financial planner and father to three, including a daughter with infantile spasms. Christian and his wife, Suzy, have been married for seven years and are the proud parents of three: Miles (1), Jude (3) and Rosalie (4), who was diagnosed with Infantile Spasms, a form of Epilepsy. We'll learn about Christian's upbringing, the important role his stepfather and spirituality have played as well as what lead to his career as a financial planner with Mika Shilanski & Associates and how this young family is embracing life's challenges head...2022-10-0737 min
Dad to Dad PodcastDad to Dad 193 Miguel Sancho of Larchmont, NY, An Emmy Award Winning TV Producer, Author & Father Of Two, Including a Son With CGDOur guest this week is Miguel Sancho, of Larchmont, NY a journalist and an Emmy award winning TV producer. Miguel and his wife, Felicia Morton, have been married for 16 years and are the proud parents of two; Lydia (13) and Sebastian (9), who was diagnosed with CGD, Chronic Granulomatous Disease, a rare genetic disorder in which white blood cells called phagocytes are unable to kill certain types of bacteria and fungi. People with CGD are constantly at risk of developing bacterial and fungal diseases that can be life-threatening.Miguel is also the author of: More Thank You Can Handle: A...2022-03-1853 minMonitor MondaysReconciling Audits at the Intersection of Health and Health EquityPublic schools and facilities will be closed. Church bells will chime, while a number of flags will fly at half-mast. Because in 1983, former Republican President Ronald Reagan proclaimed that the third Monday of January would forever be observed as Martin Luther King Jr. Day.This coming Monday, Jan. 17, Monitor Mondays will honor the slain civil rights leader with a special report recognizing efforts by various stakeholders to advance a variety of initiatives designed to improve health equity in America.Reporting on how communities of color can benefit from regulatory efforts by the Centers for Medicare & M...2022-01-1730 min
Dad to Dad PodcastDad to Dad 180 - Josh Poynter of Bowling Green, KY - The Father Of Two Boys With HemophiliaDavid Hirsch’s guest this week on the SFN Dad to Dad Podcast is Josh Poynter of Bowling Green, KY who is an estimator with Snake Steel in Nashville, TN. Josh and his wife, Monica, are parents to two boys, Tag and and their second son, Trey who was adopted from China. Both boys have Hemophilia. We’ll hear the Poynter family story including the inspiration to adopt a second child. We also learn about the Hand in Hand Adoption Agency, Kentucky Hemophilia Foundation and Kosair Children's Hospital to name a few supporting organizations. That’s all on...2021-12-1744 minTalk Ten TuesdaysCompliant CDI TechnologyThere’s never enough time to keep up with the myriad of changes confronting clinical documentation integrity specialists (CDISs). And that is why Talk Ten Tuesdays will reveal important content about a new white paper developed by the American Health Information Management Association (AHIMA) and the Association of Clinical Documentation Integrity Specialist (ACDIS), as part of a featured segment during the next edition of the weekly Internet radio broadcast.“Compliant Clinical Documentation Integrity Technology Standards,” includes information about the clinical documentation integrity (CDI) technology landscape, recognizing documentation integrity practices, evaluating compliant CDI technology vendors, developing compliant policies and pr...2021-12-1430 minMonitor MondaysRampant RACs: Auditor Industry Profiting at Providers’ ExpenseSPECIAL GUESTEdward Roche, JD, PhDDirector, Scientific Intelligence, Barraclough NY LLCALSO FEATURINGMatthew Albright; Knicole Emanuel, Esq.; Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP;David Glaser, Esq.; and Ronald Hirsch, MD, FACP, CHCQRACmonitor investigative reporter Ed Roche is intimately familiar with what he describes as the blatant abuse directed at healthcare providers by overzealous (and, in some cases, incompetent) auditors.Relying on scant evidence of actual fraud, the auditors, working in what Roche describes as a giant industry, deny claims while ignoring more the...2021-07-1930 min
Dad to Dad PodcastDad to Dad 116 - Daniel DeFabio Part 2 - Co-Founder of DISORDER: The Rare Disease Film Festival, Reflects On Losing A Son To Menkes DiseaseOn this Special Fathers Network Dad to Dad podcast It's the conclusion of host David Hirsch's conversation with multi media producer, director and marketer, Daniel DeFabio. Daniel and his wife Tina lost their oldest son Lucas (11) just months ago to Menkes Disease, a very rare genetic disorder. Daniel along with fellow SFN Mentor Father Bo Bigelow (SFN D2D #51) are co-founders of DISORDER: The Rare Disease Film Festival. It’s an emotional story that we'll hear in two parts on the Special Fathers Network Dad to Dad podcast. This is part two.To find out about Menkes Disease go...2020-09-1838 minMonitor MondaysEXCLUSIVE: The Healthcare Algorithms Arms Race is Heating UpUnlike the Cold War arms race between the then-Soviet Union and the United States, today’s arms race is being fought before computer monitors, and in the deep corners of computer laboratories. And the weapon of choice: algorithms.This fierce fighting is taking place between auditors and providers, and the stakes are high: money. Lots of it.No stranger to chronicling the former Cold War arms race, Edward Roche, RACmonitor’s investigative reporter, returns to the Monitor Mondays broadcast to report on how algorithms created by payers tend to foster a camouflage of mediocrity for prov...2020-08-3130 minMonitor MondaysBig Pharma versus 340BIn recent weeks, several major pharmaceutical manufacturers have taken actions that could lead to narrowing the 340B Drug Pricing Program, which provides outpatient drugs to safety-net hospitals, health centers, and clinics at discount prices. The savings are invested in care for patients with low incomes, living in rural communities.The actions by Eli Lilly, Merck, and Sanofi are being challenged by a coalition of safety-net providers, including 340B Health, which represents more than 1,400 340B hospitals. Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health, who will discuss...2020-08-2429 minMonitor MondaysCalifornia Whistleblower Claim Yields $24 Million Abbvie SettlementCalifornia is one of two states in the country that rewards whistleblowers for bringing forward information about private insurance fraud. A recent $24 million settlement with pharmaceutical giant Abbvie over the marketing of the company’s blockbuster drug, Humira, demonstrates the law’s effectiveness.The settlement agreement was reached last week following allegations that the company violated California’s Insurance Frauds Prevention Act. Abbvie agreed to the settlement despite continuing to deny any wrongdoing.On the next live edition of Monitor Mondays, famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will provid...2020-08-1730 minMonitor MondaysExclusive 60-Minute Broadcast: COVID-19 RulesThe omnipresent coronavirus pandemic continues to upend lives, from mundane occasions like grocery shopping to long-planned space exploration missions. The pandemic is manifesting itself from the halls of Congress to the cubicles at Centers for Medicare & Medicaid Services (CMS) headquarters, to classrooms, theatres, homes, and places of worship, among other venues.On the next live edition of Monitor Mondays, we will explore the impact of the coronavirus on audits and auditing, proposed rules, guidance, and waivers.Joining the broadcast to report on anticipated pandemic-related audits will be Dr. John K. Hall, founder of The Aegis...2020-08-1056 minMonitor MondaysSpecial Edition: DateLine CMSCenter of Medicaid and Medicare Services (CMS) has been posting proposed rules for Medicare this past week. Already, CMS has issued the final rules for Inpatient Psychiatric Facilities, Skilled Nursing Facilities, and Hospices; and we are still awaiting the final rule on the Inpatient Hospital payment rules. In light of these proposed rules we’ve asked two experts, Dr. Ronald Hirsch and Terry Fletcher to explain the significance of these proposals in a special Friday edition of Monitor Mondays.This special edition of Monitor Mondays was sponsored by Dr. Ronald Hirsch. You can visit his web...2020-08-0730 minMonitor MondaysDefund the UPICs? Auditors Attack Osteopathic MedicineWhile the battle cry of “defund the police” has emerged from Black Lives Matter activists following the death of George Floyd at the hands of Minneapolis police, could there also be sufficient reason for providers to advocate to “defund the Unified Program Integrity Contractors (UPICs)?”According to RACmonitor investivative reporter Ed Roche, UPIC auditors are attacking osteopathic medicine, and might need lessons in reading patient notes. During the next live edition of Monitor Mondays, Roche will explore the seeming incompetence of auditors when they go after such providers. Osteopathic doctors help manage pain, but there may be no cure...2020-08-0329 minMonitor MondaysThe Virus and the Audits: A Special 60-Minute News RoundupTwo major storylines are discussed during this edition of Monitor Mondays, with the exclusive 60-minute broadcast to focus on the raging coronavirus pandemic and the imminent auditing of Medicare and Medicaid claims scheduled to begin Aug. 3, as directed by the Centers for Medicare & Medicaid Services (CMS).Joining the broadcast to report on the coronavirus will be Dr. John Foggle, Adjunct Associate Professor of Emergency Medicine at the Alpert Medical School of Brown University. Offering an update on the imminent audits of Medicare and Medicaid claims will be healthcare attorney Andrew Wachler, managing partner of Wachler and...2020-07-2857 minMonitor MondaysBagnall to Alexander- finally over? An assessment of Alexander V Azar on healthcareCould Alexander VS. Azar really be over? This week's Monitor Mondays episode we've called upon or resident healthcare attorneys Knicole Emanuel Esq., David Glaser Esq. and our guest host John K. Hall MD, JD to dissect and assess the complicated case.The case has been disorganized since the beginning, possibly leaving more questions than answers. This Monitor Mondays round table will analyze procedural aspects of the case and what it could potentially mean for providers, analyze where the decision has risk for providers, and provide guidance of how providers should respond in the future.Other...2020-07-2033 minMonitor MondaysCash and Lavish Goodies to Bribe Physicians to Prescribe Novartis Drugs: Anatomy of FCA AllegationsLast week, pharmaceutical giant Novartis paid $51 million to settle a Massachusetts suit about patient copay waivers. The DOJ press release notes that this is the 14th settlement of this kind to come from the Boston area. In related news, the Government brought a suit against Regeneron alleging that the company had a scheme of very well calculated charitable giving that steered patients to its macular degeneration drug, which costs $1,850 per dose, and away from a competitor’s drug, which costs $55 per dose.We are joined this week by Mary Inman, Esq. who has the latest on the No...2020-07-1331 minMonitor MondaysA Troubling Cornucopia of COVID-Related FraudThe advent of the COVID-19 pandemic in the United States has generated nearly 2.5 million positive diagnoses, nearly 125,000 deaths – and dozens upon dozens of instances of modern-day snake-oil salesmen seeking to profit amid all of the chaos.Presenting the lead story during this edition of Monitor Mondays is Edward M. Roche, who will describe the various ways in which federal authorities are looking to stamp out the opportunistic fraudsters.Other segments to be featured in the podcast:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Mo...2020-06-2931 minMonitor MondaysRespiratory Failure Denials could become more common, get ready for post-pandemic denialsDon't let your guard down, post COVID-19 respiratory failure denials are on the horizon. Andrea Taylor from Enjoin reports why we aren't seeing denials yet and tips for appeals and waivers.Other segments featured during the podcast include:RAC Report: Healthcare attorney Knicole Emanuel, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick reports on the National Health and Nutrition Examination Survey. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright reports on the status of key healthcare legislation and the...2020-06-2228 minMonitor MondaysExclusive: Post-Pandemic COVID-19 Audits and DenialsWelcome to the new normal. You and your team continue to be challenged by consequences of the coronavirus pandemic, dealing with PPE shortages, along with confusing and oftentimes contradictory guidance from the Centers for Medicare & Medicaid Services (CMS).And now, we look onward – toward the audit horizon, and looming denials for COVID-related care. You need to be aware of ongoing payor expectations and potential risk areas for denials. Returning to Monitor Mondays to report our lead story during this edition of the weekly Internet radio broadcast will be Dr. John K. Hall, founder of The Aegis Firm, a...2020-06-1529 minMonitor MondaysExclusive: The Intersection of COVID-19 and Inpatient Rehabilitation FacilitiesFaced with rising numbers of COVID-19 cases, one hospital struggled to find adequate medical/surgical beds due to the challenges it had with discharging COVID patients. With a strong desire to address the need for surge capacity and to meet patient needs for inpatient rehabilitation, the challenge was met by the team at Henry Ford Macomb Hospital in Michigan, as you’ll learn during this edition of Monitor Mondays.Longtime RACmonitor contributor Angela Phillips will report on how the hospital kept the Inpatient Rehabilitation Facility (IRF) open, providing much-needed rehabilitation services while assisting the organization in meeting th...2020-06-0832 minMonitor MondaysExclusive: COVID-19 and Contact TracingNew York City-based RACmonitor investigative reporter Ed Roche returned to Monitor Mondays to report on developments in contact tracing: one of the newest tools in the fight to contain the deadly novel coronavirus that causes COVID-19.A hefty amount of money is being invested in contact tracing, including the development of new automated tools. But Roche reports his concern that some of the models being proposed may complicate how we exercise our Constitutional right to privacy.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney...2020-06-0129 minMonitor MondaysExclusive: Mitigating the Uncontrolled Spread of COVID-19: An Epicenter Case StudyLong-term care providers nationwide are seeking to identify ways to mitigate the uncontrolled spread of the COVID-19 virus amid vulnerable populations. Case in point: “drop teams” of physicians, infection preventionists, and nurses that could be deployed to any post-acute care space that was felt to be at risk.After seeing an outbreak at LifeCare Center in Kirkland, Wash., physician leadership and case management at MultiCare in Spokane, Wash. brainstormed ways to prevent a similar local occurrence.During this edition of Monitor Mondays MultiCare’s Ben Kartchner, MD, reports on how the drop teams are working in the...2020-05-1855 minMonitor MondaysHealthcare News Roundup: Special 60-Minute EditionWhile much of today’s healthcare news is righty focused on the efforts to stave off the global coronavirus pandemic, there is other news to report – and Monitor Mondays will have a complete wrap-up on all of it during the next edition of the weekly Internet radio broadcast, while also looking ahead.And given the tendency of the Centers for Medicare & Medicaid Services (CMS) to issue waivers and guidance with a unique style of ambiguity, a great deal of confusion also continues to come from hospitals and health systems in their efforts to remain compliant – while at the sa...2020-05-1256 minMonitor MondaysEXCLUSIVE: COVID-19 Town Hall – $50 Billion Aid Package: Pitfalls and RisksPursuant to the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the U.S. Department of Health and Human Services (HHS) has allocated $50 billion to providers and other healthcare facilities in the form of a one-time payment, which does not need to be paid back.The payment comes with terms and conditions that recipients must follow, however, including permissible uses for the payment – and failure to follow the terms and conditions, including documentation requirements, may result in an audit or other allegations of fraud and abuse.Other segments to be featured during the live broadcast in...2020-05-0455 minMonitor MondaysEXCLUSIVE: A UM Dispatch from the Front Lines of the COVID-19 PandemicThe global COVID-19 pandemic has presented a multitude of logistical challenges to healthcare providers across the country and beyond. But few are as daunting as the protocols utilization management (UM) directors are being asked to implement regarding patient status assignment.Delivering a riveting report from the front lines of the pandemic during this edition of Monitor Mondays, Stephanie Van Zandt, MD, Medical Director and Physician Advisor with BayCare Health System, a nonprofit healthcare organization that connects Florida residents with services at 15 hospitals across the state.Van Zandt describes the pitfalls and intricacies of the five-pronged...2020-04-2755 minMonitor MondaysEXCLUSIVE: The COVID-19 Impact on Medicare Appeals“Although Office of Medicare Hearings and Appeals (OMHA) office space is closed to the general public, OMHA remains open for business with employees working under maximum telework flexibilities, per U.S. Office of Personnel Management guidance.” -OMHA website.Indeed, “OMHA hearings and appeals processing measures are proceeding as scheduled,” the notice reads. “Unless an appellant is notified directly that a hearing has been postponed or canceled, appellants should continue to appear for hearings by telephone, as scheduled.”Through teleconferencing and phone calls, many administrative law judges (ALJs) are exercising flexibility in rescheduling such hearings or granting ext...2020-04-2055 minMonitor MondaysEXCLUSIVE: The COVID-19 Impact on Custodial AdmissionsCustodial admissions are problematic for hospitals under normal circumstances. But now, incredible demands placed upon facilities by COVID-19 create even more challenges, as you’ll learn during the next edition of Monitor Mondays – when Juliet Ugarte Hopkins, MD, will return to the broadcast as its special guest to report on the issues that are hampering efforts to keep hospital beds open for the patients who require care for their medical conditions.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law...2020-04-1353 minMonitor MondaysEXCLUSIVE: Hospitals on the Front Line – A Town Hall Q&AThe 1,000-bed USNS Comfort, a hospital ship that in the past has provided humanitarian relief around the world, is now anchored on Pier 90 in Manhattan to provide humanitarian relief as COVID-19, the illness caused by the novel coronarvirus, ravages New York City, now the epicenter of the pandemic. Also in New York City, the famed Jacob Javits Center has been converted to a 1,200-bed field hospital by the U.S. Army Corps of Engineers. In the meantime, the White House is warning the nation to expect the worst, reporting that up to 200,000 deaths from COVID-19 could occur. As President...2020-04-0656 minMonitor MondaysEXCLUSIVE: Monitor Mondays COVID-19 Town Hall Q&AWaivers from regulations, dire shortages of ICU beds, and scarce personal protective equipment (PPE), including gloves, gowns, and masks, are all part of the new normal as the coronavirus (COVID-19) continues to generate global headlines, especially in the United States.Amid a cacophony of misinformation, providers and patients are searching for clarity in this fog of war. That time has come. Next Monday, the long-running and authoritive voice of healthcare regulation, Monitor Mondays, will broadcast a live, 60-minute town hall, during which its panelists will answer your questions and those of your colleagues.The broadcast rundown...2020-03-3055 minMonitor MondaysEXCLUSIVE: COVID-19 by the NumbersDuring this of Monitor Mondays, senior healthcare analyst Frank Cohen, a computational statistician, reports on how anecdotal thinking is not evidence-based thinking, and it is difficult to draw conclusions without having all of the information – noting that’s exactly what is happening right now, as America grapples with the coronavirus (COVID-19).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel files her Monitor Mondays RAC Report.Audit Report: Sean M. Weiss, reports on the next audits you can expect to encounter....2020-03-2338 minMonitor MondaysConverting Medicare Patients from Inpatient to Outpatient and Condition Code 44Converting Medicare patients from inpatient to outpatient status is a compliance issue. And hospitals need to know how to process the proper billing level of care for beneficiaries. Using their benefits correctly is a responsibility, since these patients rely on caregivers to advocate for them.To help navigate these potential audit traps, we asked Mary Beth Pace, vice president of care for Trinity Health, to be our special guest during this edition of Monitor Mondays.Other segments to be featured on the podcast:COVID-19 Update: Dennis Jones, director of patient financial services...2020-03-1635 minMonitor MondaysExclusive: Big Pharma, Big Money, Big TroublesSeldom does a week pass without news about a pharmaceutical giant engaged in corporate wrongdoing. This week, the feds announced that they had filed a complaint under the False Claims Act (FCA) against Mallinckrodt ARD LLC. The complaint alleges that the pharmaceutical company “avoided paying hundreds of millions of dollars in Medicaid rebates due to significant drug price increases” as a result of “large increases in the price” of its drug H.P. Acthar Gel.Recently, pharmaceutical company Sanofi-Aventis U.S., LLC, agreed to pay $11.85 million to resolve allegations that it violated the False Claims Act by paying k...2020-03-0931 minMonitor MondaysHospital Price Transparency: Clearing Up the Compliance ConfusionContentious and confusing, the Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule will become effective Jan. 1, 2021.On the surface, the requirements are straightforward: hospitals and health systems must make accessible all negotiated managed care rates in a machine-readable format, along with a list of 300 “shoppable” items –non-urgent, high-volume items and services – on their website or via an interactive tool for consumers. But below the surface lurks confusion. That is why we asked Frederick Stodolak, the president of Panacea Healthcare and a subject matter expert on hospital pricing, to be our special guest during this edition of Monit...2020-03-0231 minMonitor MondaysExclusive: The Plight of Rural Health, Part IILike a destructive earthquake, recent news from The Chartis Center for Rural, documenting the accelerated rate of closures among rural hospitals, is sending shock waves through rural communities.As with the Richter scale, the closure of one rural hospital is likely to have an exponential impact on all rural health. And the stark reality is that, as of January 2020, a total of 120 rural health facilities have closed their doors.Leslie Marsh, the chief executive of Lexington Regional Health Center in Lincoln, Neb., returns to Monitor Mondays and reports on precipitous peril for rural hospitals, which...2020-02-2427 minMonitor MondaysExclusive: The Plight of Rural Health, Part IWith a 30,000-foot view of rural healthcare policies and regulations emanating from Washington, D.C., Leslie Marsh still recognizes the importance of having boots on the ground, serving as the chief executive of Lexington Regional Health Center in Lincoln, Neb.Marsh, who also serves as vice president of board of directors for the ruralMED Health Network, addresses the ubiquitous Z codes and their impact on the rural population, among other serious issues facing rural healthcare providers, during this edition of Monitor Mondays.Other segments to be featured during the podcast includes:RAC Report: 2020-02-1730 minMonitor MondaysExclusive: The AI Arms Race in Medicare AuditsThe artificial intelligence (AI) arms race is heating up. The use of AI by healthcare providers responding to a wave of audits initiated by AI systems is an escalation. As the government continues to deploy AI systems in Medicare audits, providers will respond with their own counter-measures, also using AI. Reporting our lead story during the next edition of Monitor Mondays will be RACmonitor investigative reporter Edward Roche, who continues to monitor the intensifying showdown. Other segments to be featured on the podcast include:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest a...2020-02-1030 minMonitor MondaysWar on Drugs: EHR Vendor Admits to Receiving Illegal Kickbacks from Opioid PharmasPractice Function, Inc., a unit of Allscripts Healthcare Solutions Inc., engaged in an "abhorrent" scheme to help a pharmaceutical company push its extended-release opioids, according to a news release posted on Monday by the U.S. Department of Justice.The company agreed to pay $145 million to resolve criminal and civil investigations relating to its electronic health records (EHR) software. Practice Fusion admitted soliciting and receiving kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications. Famed whistleblower attorney Mary Inman reports our lead story this edition...2020-02-0332 minMonitor MondaysBalancing Billing: A Swirling ControversyWhat once appeared to be a legislative slam dunk is now mired in controversy, this time fueled by the recently formed coalition dead-set against the proposed use benchmark payments.The Coalition Against Rate-Setting considers the practice tantamount to price-fixing. What will happen next to the compromise legislation, which was hammered out with bipartisan congressional support? Matthew Albright, chief legislative affairs officer for Zelis, reports our lead story during this edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on...2020-01-2731 minMonitor MondaysWar on Drugs: Court Orders AmerisourceBergen to Hand Over Opioid-Related Documents to Pension FundAmerisourceBergen, one of the nation’s largest pharmaceutical wholesalers, must turn over records to pension fund shareholders probing to determine wrongdoing by the drug distributor’s board for the company’s multi-billion-dollar legal exposure from the nationwide opioid crisis.AmerisourceBergen was already facing two congressional investigations, plus a Drug Enforcement Administration (DEA) probe. Reporting on this developing story is famed whistleblower attorney Mary Inman, a partner in the London law office of Constantine Cannon.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the...2020-01-2030 minMonitor Mondays2020: Look Out, Look Ahead2020 ushers in a formidable decade of healthcare regulations and a perilous audit landscape, populated with aggressive auditors who will be aided by artificial intelligence to review and deny claims.Decisions being made in Washington, D.C. will impact every practice, facility, and health system. With so many major changes taking place, you need to stay informed and alert – and RACmonitor and Monitor Mondays will help you stay out in front of the issues that will alter the delivery of healthcare, both now and through this new and unchartered decade.Monitor Mondays host and RACmonitor Publisher Ch...2020-01-1358 minMonitor MondaysHome Health and Hospice: State of the UnionIt’s been a rough year for home health and hospice providers, especially in light of the fact that the Centers for Medicare & Medicaid Services (CMS) included a reduction in the base payment rate of 8.01 percent in the Patient-Driven Groupings Model (PDGM) of the 2020 Home Health Prospective Payment System Rate Update.Returning to Monitor Mondays is William Dombi, president of the National Association for Home Care and Hospice, who will provide a regulatory update for his association as its members prepare for another year of audits.Other segments to be featured on the broadcast include th...2019-12-0931 minMonitor MondaysRural Health: State of the UnionRural hospitals are an endangered species in America, with extinction a real possibility. In fact, the North Carolina Rural Health Research and Policy Analysis Center report that more than 120 hospitals have closed nationwide since 2005, with nearly 70 percent (or 83) of those closures occurring since 2010. Adding insult to injury is the recent announcement from the Centers for Medicare & Medicaid Services (CMS) that Monday, Dec. 2 is the deadline for critical access hospitals (CAHs) to submit a hardship exception to avoid the “Medicare downward payments.” To qualify, those hospitals must illustrate the use of certified electronic health record technology (CEHRT) in order...2019-12-0231 minMonitor MondaysDischarge Planning Conditions of Participation: The IMPACT and ConsequencesMany hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.“CMS has spent the last two years working on the IMPACT Act, and they are now ready to implement,” reports Mary Beth Pace, vice president of care management at Trinity Health. “Does the CoP resemble anything akin to what you thought they would come out with? It does not to us. Let me ref...2019-11-2630 minMonitor MondaysMonitoring Patient Mortality: Compliance and QualityPatient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care. Reporting the lead story during this episode of Monitor Mondays is Melinda Battaile, MD, physician advisor and clinical documentation advisor for Vidant Health in Greenville, N.C.Other segments to be featured on the broadcast include t...2019-11-1830 minMonitor MondaysKnown by the Company You Keep: Disclosures of AffiliationsDirect or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.The new rulemaking this so, 52 CFR, Section 424.519, Disclosures of Affiliations, authorizes CMS to deny or revoke enrollment based on disclosures of certain affiliations the agency determines to pose an undue risk of fraud, waste, or abuse.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates. Mr. Wachler also discusses what constitutes an “affiliated entity” and what even...2019-11-1130 minMonitor MondaysAnatomy of an Algorithm: Optum Algorithm Under Fire for Alleged Racial BiasGiant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.The results of a study published last week by Science revealed what researchers identified as a "significant racial bias" in Optum’s algorithm, which reportedly undervalues the healthcare needs of black patients. Although Science didn’t mention Optum by name, other news organizations have confirmed that it was, indeed, Optum.Reporting on this developing story during this edition of Monitor Mondays is RACmonitor investigative reporter and New York attorney Edward Roche, director of business intelligence for Barraclough New Yo...2019-11-0432 minMonitor MondaysCMS Site-Neutral Payments: Hospitals Win, CMS Loses, but the War is Not OverA federal court on Tuesday found that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced payments for hospital outpatient services delivered outside of hospitals in outpatient provider-based settings. The Centers for Medicare & Medicaid Services (CMS) could appeal the court’s decision on its site-neutral payment rule for hospital outpatient services. Score one for hospitals, but the war is far from over.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other se...2019-10-2831 minMonitor MondaysFeds Putting the Squeeze on Medicare and Medicaid Payments: $252.6 Billion in Cuts ReportedActs of Congress plus regulatory cuts by the Centers for Medicare & Medicaid Services (CMS) are estimated to reduce federal payments to hospitals by $256.6 billion from 2010 to 2029, according to a study released this week and commissioned by the American Hospital Association (AHA) and the Federation of American Hospitals.Reporting on this developing story during this edition of Monitor Mondays is former CMS official Matthew Albright, chief legislative affairs officer for Zelis Healthcare.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest...2019-10-2129 minMonitor MondaysPDPM: New Reimbursement Model is Driving DisruptionThere have been recent media reports of layoffs and pay cuts among the ranks of those working in the nation’s skilled nursing facilities (SNFs) as a result of the new Medicare reimbursement model from the Centers for Medicare & Medicaid Services (CMS): the Patient-Driven Payment Model.Reporting on these new changes during this edition of Monitor Mondays will be Toby S. Edelman, senior policy attorney for the Center for Medicare Advocacy. The new PDPM system reverses the financial incentives that existed for 20 years. Instead of paying more money for more minutes of therapy that a resident at a...2019-10-1431 minMonitor Mondays340B Drug Program in CMS CrosshairsThe Centers for Medicare & Medicaid Services (CMS) reportedly will collect information from hospitals about the prices they pay for drugs through the 340B discount program.How will the information gathered by CMS be used, moving forward? And why is this action being taken by CMS? The agency has a history of attempted cuts to 340B reimbursement; the most recent such action by CMS occurred last December, after which a federal judge ruled against the move.Reporting our lead story during this edition of Monitor Mondays is Maureen Testoni, president and CEO of 340B Health.2019-10-0730 min
Dad to Dad PodcastDad to Dad 68 - John Dodd of Brentwood, TN, A Wealth Manager & Father of Two Including a Daughter With Down SyndromeJohn Dodd of Brentwood, TN who is a wealth manager with Ronald Blue & Co. is our guest on this Dad to Dad podcast. John and his wife, Kathleen, have been married for 34 years and are the proud parents of two daughters; Joy (23) and Grace (21) who has Down Syndrome.He’s also had some significant challenges in his life, including his physician father's suicide, but through it all has remained incredibly upbeat, which is a testimony to his deep faith. We also learn about his David Letterman style 'Top 10 List For SN Dads." He’s a model for...2019-10-041h 03Monitor MondaysDeveloping Story: Virginia Governor and MCOs Sued by Behavioral Health ProvidersAs expected, the Governor of Virginia, Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Wednesday, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.The suit was filed by the Potomac Law Group.During this edition of Monitor Mondays, healthcare attorney Knicole Emanuel, a partner in the aforementioned law firm and a member of the RACmonitor editorial board, provides an update on the lawsuit as it makes it...2019-09-3029 minMonitor MondaysDeveloping Story: Virginia’s Behavioral Health Providers Under SiegeOther segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports our lead story on the mass terminations of behavioral healthcare providers in Virginia. Emanuel has also been at ground zero in Richmond this past week, representing the aforementioned association there. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that...2019-09-2330 minMonitor MondaysNo Time for SNFs: PDPM Becomes Effective Oct. 1Time is running out for skilled nursing facilities (SNFs). Come Oct. 1, 2019, time will be a thing of the past for such providers, as there will be a new payment methodology for SNFs: The Patient-Driven Payment Model (PDPM). Under PDPM, reimbursement for Medicare Part A patients in SNFs will be driven by patient condition, rather than by therapy minutes provided. Documentation is crucial to avoid a Recovery Audit Contractor (RAC) audit. Reporting our lead story during this edition of Monitor Mondays will be healthcare attorney Knicole Emanuel. Other segments to appear during the live broadcast include th...2019-09-1629 minMonitor MondaysRACs and SNFs: Referrals in the CrosshairsDo you know the statutory and regulatory requirements to avoid jeopardizing payment for you and your skilled nursing facility (SNF)?You need to know because the Recovery Audit Contractors (RACs) and other contractors are reviewing SNF referrals. Reporting our lead story is physician and attorney John K. Hall, founder of the Aegis Firm. Hall reviews such statutory and regulatory requirements while also making recommendations for audit readiness.Other segments to appear during the broadcast:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report the latest audits by RACs and...2019-09-0930 minMonitor MondaysUnderstanding the Rules of Engagement at the ALJ LevelDespite an order from the U.S. District Court for the District of Columbia for the federal government to reduce the backlog of Medicare appeals, the requirements for victory in front of an Administrative Law Judge (ALJ) remain the same.During this edition of Monitor Mondays, David Mullens, a California healthcare attorney, will address some of those fundamentals.Other segments to appear during the podcast include:RAC Report: Healthcare attorney Knicole Emanuel returns to the broadcast to report on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel...2019-08-2631 minMonitor MondaysTwo Suicides and a Bankruptcy: Have Some Auditors Gone Rogue?Two suicides, and a provider-driven into bankruptcy – and all because two ex-employee criminals looking for some fast cash lied to the state under the pretext of being whistleblowers tipping off Medicaid auditors, creating a cascade of unbelievable tragedy. RACmonitor Editorial Board member, investigative reporter, and New York attorney Edward Roche returns Monitor Mondays with this exclusive story about a durable medical equipment (DME) provider facing auditors who, in his words, had gone rogue.Other segments to appear during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel returns to the...2019-08-1931 minMonitor MondaysAn Unsolved Mystery: Lifting the Suspension of Medicare FundsObtaining an injunction in federal court to lift a suspension of access to Medicare or Medicaid funds is rare, according to healthcare attorney Knicole Emanuel. As she was preparing to file such an injunction in federal court recently, the prepayment review suspension was lifted. Emanuel, a partner in the Potomac Law Firm and a regular panelist on Monitor Mondays, reports on the possible reasons that might explain such a mystery during this edition of Monitor Mondays.Other segments to appear includes:IRF Report: Angela Phillips, considered to be one of the nation’s f...2019-08-1230 minMonitor MondaysChanges in the Works for Home Care ProvidersThe Center for Medicare Advocacy (CMA) is reporting news about a new payment structure for home care, noting that such a plan is likely to adversely affect a hospital’s ability to acquire home care services for some patients. One of the factors to determine the payment to a home care agency for an episode of care is the origin of the patient, with two rates – one for the community, and one for the institution – and obviously, the referral from the community will have a lower payment. Judith A. Stein, JD, executive director of the Center for Medicar...2019-08-0530 minMonitor MondaysMedicare Advantage Plans: Making Up Their Own RulesReports of payer abuse continue unabated, and among the worst offenders cited by physician advisors are Aetna, Humana, and UnitedHealthcare.Case in point: When a physician advisor recently challenged an Aetna medical director about an observation payment, the medical director didn’t have an answer, but retorted by simply saying “whatever is in our contract.”This is but one example of Medicare Advantage (MA) plans misusing commercial guidelines and making up their own rules, as they see fit, in order to avoid paying hospitals equitably for the care they provide to their members. Reporting on this d...2019-07-2930 minMonitor MondaysAuditors Will Target SNF Patient Condition, Not Services and Time RenderedThere was a time when therapy documentation was the focus of Recovery Audit Contractor (RAC) audits. Under the Patient-Driven Payment Model (PDPM), however, reimbursement for Medicare Part A patients being treated in skilled nursing facilities (SNFs) will be driven by patient condition, rather than therapy minutes. And this creates a target-rich opportunity for auditors, because certain documentation can easily lead to higher reimbursement – and the likelihood of audits leading to claim denials. Reporting on this development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.Othe...2019-07-2231 minMonitor MondaysWhat to Do When a Government Agent Knocks on Your DoorAn older physician, practicing family medicine for 46 years, opens his door one day and finds an individual who says he works for the U.S. Department of Justice (DOJ), demanding to see medical records.In short order, the agent leaves the premises with charts, and later, the family physician finds himself facing the prospect of a trial by jury that the DOJ is demanding to quantify civil monetary fines and penalties. What could have possibly triggered this investigation?Reporting this developing story during this edition of Monitor Mondays is Shannon DeConda, founder and president of...2019-07-1529 minMonitor MondaysThe Seema Verma Blog Post That’s Making Providers AnxiousSeema Verma, the Centers for Medicare & Medicaid Services (CMS) administrator, has raised the anxiety levels of healthcare providers with her blog post on May 2, 2019. With an ominous warning, Verna said that the RAC ADRs will be guided by the volume of claims a provider submits based on an undefined “type” of a claim. Does this signal that observation claims could be reviewed simply based on the volume of claims? Reporting this developing story during the next edition of Monitor Monday will be John K. Hall, MD, founder of The Aegis Firm. Other segments to appear during the live b...2019-07-0830 minMonitor Mondays340B Drug Survey Reveals Help to Rural HospitalsUnder siege by policymakers, the controversial 340B drug discount program appears to be widely embraced by its 1,300 member hospitals that participated in a recent national survey. Moreover, the survey revealed that members are using savings to provide critical services and access to care to patients with low incomes and those living in under-served rural communities. Reporting on this survey results and the import of its findings during this edition of Monitor Mondays Maureen Testoni, president and CEO for 340B Health. Other segments to appear during the live broadcast include:RAC Report: Healthcare at...2019-07-0131 minMonitor MondaysYea or Nay? Surprise Balance Billing Legislation Heads for a VoteU.S. Sen. Lamar Alexander (R-Tenn.), chair of the Senate Health Committee, appears to be ready to shepherd his 165-page draft legislation on surprise balance billing for a vote next week. In their push to get legislation prohibiting such billing through before the August recess, both the House and Senate have held hearings in the past two weeks on the various approaches to the problem. Those hearings have made the industry battle lines clearer, in terms of how the various industry sectors think that out-of-network providers should be compensated by payors. Although no single approach ap...2019-06-2432 minMonitor MondaysResponding to Emergency Department Claim DenialsMost likely your facility has been hit with claim denials for providing emergency department level-of-care coding. Such denials are not new, and in fact, RACmonitor and Monitor Mondays have been reporting about these denials for a number of years. But how can you and your team effectively deal with them? What tools and techniques are available? During this edition of Monitor Mondays, John K. Hall, MD, founder of The Aegis Firm and the newest member of the RACmonitor editorial board, will make his debut appearance on the broadcast to report on how payers are denying cl...2019-06-1729 minMonitor MondaysA Legend Returns to Monitor MondaysDaniel Levinson, former head of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), will make his first broadcast appearance on Monitor Mondays since his announced retirement earlier this year.During his 15-year stint as the nation’s top healthcare watchdog, Levinson oversaw investigations into controversial health issues, including what was described as the largest healthcare fraud takedown in history in July 2017, when more than 400 defendants in 41 judicial districts were charged with participating in schemes involving about $1.3 billion in false billings to Medicare and Medicaid. Other segments to appear on the...2019-06-1028 minMonitor MondaysNo Surprise: Stakeholders Fight to Solve Surprise BillingThe fight is on, and combatants are sparring over how to implement a legislative ban on surprise balance billing. In recent congressional testimony, providers, payers, and hospitals have clashed on how to keep patients from being stuck with huge expenses, with each side blaming the other for being intransigent. One of the major issues is how out-of-network doctors should be reimbursed, and at what rate. Reporting our lead story during this edition of Monitor Mondays will be Matthew Albright, chief legislative affairs officer for Zelis and the former Director of the Administrative Simplification Group of th...2019-06-0329 minMonitor Mondays340B Dodges Another BulletA federal judge has upheld a lower court’s ruling that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced the 2018 Medicare reimbursement rate for drugs covered by the federal 340B Program. U.S. District Court Judge Rudolph Contreras, sitting in the District of Columbia, issued the ruling recently in the matter of American Hospital Association v. Alex M. Azar, HHS Secretary, ordering HHS back to the drawing board and warning it to act with haste to make a correction. Reporting our lead story during this edition of M...2019-05-2029 minMonitor MondaysInpatient versus Outpatient: Status of Psych Patients in the EDConfusion appears to be hampering important decisions when it comes to patient status, particularly the question of inpatient versus outpatient – and more specifically when it comes to the status of psychiatric patients who are waiting in the emergency department to be transferred to a psychiatric hospital. The subject is not only newsworthy but also one that seems to be causing consternation and frustration.Reporting our lead story during this edition of Monitor Mondays is Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., a telemedicine company providing psychiatric care to patients throughout the United States in...2019-05-1329 minMonitor MondaysNew Proposal for Dual-Eligibility Beneficiaries: Good Intentions or Cost Cutting?The Centers for Medicare & Medicaid Services (CMS) is inviting state Medicaid directors to partner with them to test new approaches to better serve those who are dually eligible for Medicare and Medicaid.More than $300 billion is spent annually by CMS and states to care for the dual-eligibles, and many of the 12 million of those beneficiaries have multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. Could the CMS initiative suggest cost-cutting, administrative burden reductions, or true innovation? RACmonitor national correspondent J. Paul Spencer, a senior health consultant for DoctorsManagement, reports our...2019-05-0629 minMonitor MondaysCongressional Action on Surprise Balance BillingNews reports have been circulating of late about proposed state and federal legislation targeting healthcare “surprise” balance billing.Reporting our lead story during this edition of Monitor Mondays will be Matthew Albright, chief legislative affairs officer for Zelis. The former Director of the Administrative Simplification Group for the Centers for Medicare & Medicaid Services (CMS), Albright will also report on drug rebate discussions and how those discussions are being impacted by broader reform proposals such as Patient Protection and Affordable Care Act (PPACA) stabilization, outright repeal, and Medicare-for-all.Other segments to appear on the broadcast include:2019-04-2930 minMonitor MondaysECAPE: Revealing the New Backlog Buster at OMHANew from the Office of Medicare Hearings and Appeals (OMHA) is ECAPE—an electronic case management and workflow system designed to help reduce the backlog of appeals. ECAPE is expected to streamline and manage electronic filings, exhibiting, scheduling, and general case management. Reporting this breaking news story is Andrea Monson, who is the head of the ECAPE project for OMHA. Other segments to appear on the broadcast include:Monday Focus: Healthcare attorney Andrew Wachler, managing partner at Wachler & Associates, will provide context and perspective to the ECAPE system at the OMHA.2019-04-2230 minMonitor MondaysIs Disallowing an Appeals Process for a Decrease in Medicare Payments Unconstitutional?The Centers for Medicare & Medicaid Services (CMS) recently announced that 800 hospitals will be penalized this year for yielding poor results in the Hospital-Acquired Condition (HAC) Reduction Program, including 110 hospitals that are being penalized for the fifth year in a row (the HAC Reduction Program has only been in existence for five years). The Code of Federal Regulations does not allow a hospital to appeal the determination of poor results in this program, whereas if you are penalized by a Recovery Audit Contractor (RAC) or a Zone Program Integrity Contractor (ZPIC), you do have the right to appeal. W...2019-04-1531 minMonitor MondaysObservation and Outpatient Status: Heading for Another Court FightThe use and apparent abuse of observation and outpatient status are expected to have its day in court – again. That’s because a federal judge has denied the government’s bid to put a stop to a landmark class-action lawsuit centering on patient status, paving the way for a trial expected to begin later this year. As reported by RACmonitor, in the court case Alexander v. Azar, the plaintiffs allege they were forced to pay up to $30,000 apiece for skilled nursing facility (SNF) care after being designated outpatients in observation status rather than inpatients, according to a press r...2019-04-0831 minMonitor MondaysCMS and Prescription Drug Prices, Part II: 340B State of the UnionIn the final installment of a two-part series on prescription drug prices, during this edition of Monitor Mondays we will report on the latest initiative on a new “war on drugs” – the anticipated rollout by the Health Resources and Services Administration (HRSA) of a new secure website that hospitals, clinics, and health centers can use to see what price they should be paying for any drug covered under the 340B federal drug program. Reporting on this development will be Maureen Testoni, Esq., president and CEO for 340B Health. Other segments to appear on the broadcast include:Monda...2019-04-0130 minMonitor MondaysCMS and Prescription Drug Prices, Part I: 2019 Drug Spending DashboardsIn the first portion of a two-part series on prescription drug prices, during this edition of Monitor Mondays we report on the Centers for Medicare & Medicaid Services (CMS) Drug Spending Dashboards with data for 2017.First released in May of last year, the new dashboards include information on manufacturers that are responsible for price increases, plus pricing and spending data for thousands of more drugs across Medicare Parts B and D and Medicaid. Reporting Part I of the series will be Timothy Powell, a regulatory expert and a RACmonitor national correspondent. During Part II, scheduled for A...2019-03-2528 minMonitor MondaysChallenging the Ambiguity of an Agency’s RegulationsThe preponderance of ambiguously worded regulations from federal agencies – think the Centers for Medicare & Medicaid Services (CMS) – will be at the center of a major legal challenge coming March 26 to the nation’s highest court, and you’ll hear the details here during this edition of Monitor Mondays.That’s when Jennifer Gustafson will report our lead story, focusing on the U.S. Supreme Court (SCOTUS) taking up the case of Kisor vs. Wilkie (U.S. Marine James Kisor vs. the U.S. Department of Veterans Affairs).The dispute is over denied Veterans Affairs (VA) benefits...2019-03-0430 minMonitor MondaysForensic Audits: Spurious or Genuine? Part IIReaction to the reporting here on forensic audits continues to reverberate. During last week's Monitor Mondays broadcast, Amanda Gilliland, a revenue integrity nurse auditor at UW Health in Madison, Wisc., reported on her experience and efforts to appeal what she describes as "spurious" denials. As reported last Monday, these denials are for commonly billed services and items such as IV solutions, supplies, point-of-care (POC) labs, venipuncture, respiratory therapy services, etc.Michael Lewis, president of Financial Review Services of Houston, Tex. continues our reporting on this topic during this episode.The episode rundown also includes:2019-02-2529 min
Lead Sell and Scale014 - Hiring Freeelancers-Nate Hirsch-FreeeUp’s CEO & FounderVisit https://ecombillionaires.com/episode014 for show notes and links.
Are you hiring freelancers for your business?
Hiring freelancers is a great stepping stone for a business that has yet to hire full time employees. Its also great for taking on special projects, or extra tasks.
And better yet, you might just find a freelancer that is so good, you decide to make them your first full time employee.
What’s the downside of hiring freelancers?
I’d say its the varying skill set. You never really know how someone is going to perform for you, and your business, until they...2019-02-0726 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 Mondays2019 Medicare Physician Fee Schedule and the Outpatient Prospective Payment System: Analyzing the Impacts on Providers The Medicare Physician Fee Schedule/resource-based relative value scale (MPFS/RBRVS) regulations were formally published in the Federal Register on July 27, 2018. The Outpatient Prospective Payment System/Ambulatory Payment Classifications (OPPS/APCs) was released two days prior. Both were reported by RACmonitor. Although you can expect the final changes to published in early November, for a contemporary analysis listen to Duane Abbey during this edition of Monitor Mondays. Duane Abbey is president of Abbey and Abbey Consulting, Inc., and is RACmonitor contributing editor and a frequent panelist on Monitor Mondays. The broadcast rundown also will include: Monday Foc...2018-08-0630 minMonitor MondaysBeware: Emerging New Payer Denial for COPDThere’s a new and disturbing payer denial—a situation that has caught the attention of the Brundage Group. An insurance company removed the diagnosis of COPD exacerbation because the treating physician chose not to treat using steroids. Could this denial be happening at your facility? Dr. Brett Hoggard, chief medical officer for the Brundage Group, reports on this new and disheartening denial technique. The broadcast rundown also will include: The RAC Report: RACmonitor Legislative Analyst Emily Evans, managing director of health policy for Washington, D.C.-based Hedgeye, reports on the latest developments of the Recov...2018-07-3029 minMonitor MondaysMedicare and Medicaid RAC Audits: How Auditors Get It WrongRACmonitor was founded in 2008 to provide news and information for healthcare providers on the emergence of the government’s Recovery Audit Contractor (RAC) program. From a Centers for Medicare & Medicaid Services (CMS) demonstration in that year, and continuing to the national rollout in 2010 (coincidentally, the year of Monitor Mondays’ national debut), we have been reporting on activities not only of the RACs, but also the Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs), and the Quality Improvement Organizations (QIOs).
But why, after nearly 10 years, do these auditors still tend to get auditing wrong? Providing insight into this...2018-03-1230 min
Coaching for RealIt All Started From a College Dorm RoomTired of posting jobs and interviewing a never-ending assortment of applicants, assuming all the risk with no guarantee of their reliability? What if you could build an online team as you want with access to the top 1% of online workers available on a first come, first serve basis? How convenient would it be if you could request the exact worker you need and have an introduction within 24 hours? Seem too good to be true? Absolutely not!
Join us as we talk to Nathan Hirsch, serial entrepreneur and the founder of Freeeup.com, the online hiring marketplace specialized for eCommerce and...2017-08-2456 min