Monitor Mondays

A Cautionary Tale: Submitting a Higher-Weighted DRG

June 28, 2021 Ronald Hirsch, MD | Knicole Emanuel Esq. | David Glaser, Esq. | Ellen Fink-Samnick | Matthew Albright | Susan Gatehouse Episode 460
Monitor Mondays
A Cautionary Tale: Submitting a Higher-Weighted DRG
Show Notes

If your facility is considering submitting an amended claim request for a higher-weighted diagnosis-related group (HWDRG), be aware: the Centers for Medicare & Medicaid Services (CMS) has the authority to have your amended claim reviewed by a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).

And that alone could open up Pandora’s Box. Reporting our lead story during the next live edition of Monitor Mondays will be Susan Gatehouse, founder and CEO for Axea Solutions. Gatehouse, also a popular panelist on Talk Ten Tuesdays, will report on the possible consequences of such an action while providing guidance on how to ensure all your ducks are in a row.

Other segments to be featured during the live broadcast include the following:

  • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment.
  • RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
  • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.
  • Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.
  • Social Determinants of Health: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the latest news that’s occurring at the intersection of healthcare and socioeconomics. Ellen will also conduct the Monitor Mondays Listeners Survey.