Monitor Mondays
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/
Episodes
324 episodes since 2018
Exposing Challenges to Getting Paid by Medicare Advantage
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 gu...
September 16, 2024
•
Season 13
•
Episode 606
•
29:00
How to Ensure Correct Inpatient Status
What’s wrong with this picture?With more than 10 years of the Centers for Medicare & Medicaid Services (CMS) Two-midnight Rule now behind us, one would presume that most healthcare professionals should know what determines an inpatie...
September 09, 2024
•
Season 13
•
Episode 605
•
30:12
New Study Reveals America’s Big Hang-up with Healthcare
A comprehensive new survey featuring responses from more than 1,500 U.S. patients reveals that they are not only frustrated by poor provider support, but also are experiencing tangible health setbacks – especially when waiting to refill prescri...
August 26, 2024
•
Season 13
•
Episode 604
•
28:58
Federal Officials Announce Medical Relief in Wake of Hurricane
In response to the devastation caused by Hurricane Debby, now Tropical Storm Debby, the Centers for Medicare & Medicaid Services (CMS) has announced additional resources and flexibilities to support the affected states of Florida, Georgia, ...
August 19, 2024
•
Season 13
•
Episode 603
•
27:15
There’s a New Sheriff in Town: New DOJ Program Intends to Snare Even More FCA Fraudsters
The U.S. Department of Justice (DOJ) has a new whistleblower reward initiative called the DOJ Corporate Whistleblower Awards Pilot Program.The Program, which seeks to fill gaps left by existing whistleblower reward programs, incentivizes...
August 12, 2024
•
Season 13
•
Episode 602
•
28:37
FY 2025 IPPS: The Clinical Report
The Inpatient Prospective Payment System Final Rule for Acute Care and Long-Term Care hospitals in the 2025 fiscal year (FY) continues to generate interest from providers, payers, hospital administrators, vendors, and consultants. But what are ...
August 05, 2024
•
Season 13
•
Episode 601
•
31:07
“Do the Crime, Pay the Fine:” DaVita to Pay$34 million to Resolve Allegations of Illegal Kickbacks
Denver-based DaVita Inc. has agreed to pay slightly more than $34 million to resolve allegations that it violated the False Claims Act (FCA).The U.S. Department of Justice (DOJ) reported in a news release that DaVita paid kickbacks to induc...
July 29, 2024
•
Season 13
•
Episode 600
•
27:28
End of the Road for the ALJs?
Could the end be near for the administrative law judges of the Centers for Medicare & Medicaid Service (CMS). What about the Office of Medicare Hearings and Appeals (OMHA)? Could these entities be gone from the audit landscape?Case i...
July 22, 2024
•
Season 13
•
Episode 599
•
30:07
Handle with Care: Taking Steps for Safe Transitions
Have 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 transiti...
July 15, 2024
•
Season 13
•
Episode 598
•
29:12
No More Chevron? What Happens Next?
For nearly four decades, a judicial principle known as “Chevron deference” has guided the federal courts as they reviewed litigation associated with federal agencies. Chevron deference allowed legislators to leave statutes somewhat vague, assum...
July 08, 2024
•
Season 13
•
Episode 597
•
29:25
Special Alert: DOJ Cracks Down on Nearly 200 Involved in Major Healthcare Fraud Schemes
In a late-breaking press release, the U.S. Department of Justice (DOJ) announced late Thursday that the agency had charged nearly 200 individuals accused with involvement in various healthcare fraud schemes estimated at $2.7 billion. Charges we...
July 01, 2024
•
Season 13
•
Episode 596
•
28:55
How a Different Type of Whistleblower Created a Lesson Worth Learning
A recent federal court decision in New Jersey demonstrates the viability of a different kind of whistleblower – in this case, a privately defrauded party.The most common type of a whistleblower under the False Claims Act (FCA) tends to b...
June 24, 2024
•
Season 13
•
Episode 595
•
28:57
The Human Touch at the Intersection of Artificial Intelligence and Denied Claims
Artificial intelligence (AI) is fast becoming a fixture in healthcare revenue cycle management (RCM), where finance leaders are desperate for ways to relieve understaffed departments struggling under unprecedented volumes of third-party audit d...
June 17, 2024
•
Season 13
•
Episode 594
•
28:50
OIG On the Prowl: Semi-Annual Report to Congress
They’re looking for fraudsters, going on the prowl for bad actors, as revealed in the latest semi-annual report to Congress compiled by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). In this latest rep...
June 10, 2024
•
Season 13
•
Episode 593
•
31:15
Jail Time, or Hefty Fine?
Most healthcare investigations by the U.S. Department of Justice (DOJ) result in settlements. Many times, the complete details of the settlements in underlying government cases are not fully disclosed. But sometimes, a provider ends up at trial...
June 03, 2024
•
Season 13
•
Episode 592
•
28:40
New Medical Technologies: Are They Audit-Proof?
A deep dive into microbiology can reveal an up-close look at the cells that make up organs of the human body – and corresponding cancer treatments that leave no trace of damage.The science of medicine appears to be moving at the speed of...
May 20, 2024
•
Season 13
•
Episode 591
•
27:01
Healthcare Whistleblower Roundup: Recent Settlements Reach Nearly $10 Million
Two recent settlements to resolve allegations of violating the False Claims Act – both involving the virulent COVID-19 – are the latest in a series of actions that will be reported on during the next edition of Monitor Mondays by famed whistleb...
May 13, 2024
•
Season 13
•
Episode 590
•
28:21
The AI Arms Race in Healthcare Auditing: Handicapping Winners and Losers
The arms race is heating up.On one side there are healthcare providers, and on the opposing side, an army operated by the auditors. Who will be the winners and losers?Are you safe? And how do you protect your facility from claim d...
May 06, 2024
•
Season 13
•
Episode 589
•
29:07
The Value of Peer-to-Peer Discussion
Do you have peer-to-peer (P2P) discussions?Are they useful? Are they valuable? And how do you know?Our own physician and attorney, Dr. John K. Hall, will offer his unique take on the value of P2P interactions and how you should measure ...
April 29, 2024
•
Season 13
•
Episode 588
•
28:09
The Two-Midnight Rule: Navigating Treacherous Medicare Currents
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 c...
April 22, 2024
•
Season 13
•
Episode 587
•
27:49
Defense Strategies Against AI Audits
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 inst...
April 15, 2024
•
Season 13
•
Episode 586
•
40:16
Medicare Advantage “Schemes” in the DOJ Crosshairs
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...
April 08, 2024
•
Season 13
•
Episode 585
•
31:06
Whistleblower Update: $300 Million in Alleged Fraud
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 ...
April 01, 2024
•
Season 13
•
Episode 584
•
31:19
How to Achieve a Clear Vision for Hospital Price Transparency
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...
March 25, 2024
•
Season 13
•
Episode 583
•
29:21
The Fix is in: Hospital Price Transparency Rule
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 w...
March 18, 2024
•
Season 13
•
Episode 582
•
28:32