x

75% of people globally want unbiased news (Pew Research) but are concerned they're not getting that.

Get balanced coverage with Symby. See how stories are covered across diverse outlets and spot when one side covers a story the other skips.

PODCAST

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/

education medicine

All Episodes

29:41

Hot Off the Presses: Latest Issues Impacting Medicare...

Monitor Mondays ·

2025/02/24

During the next edition of Monitor Mondays, special guest Bill Dombi, senior counsel with Arnall, Golden, and Gregory, will offer an update on the hot-button issues affecting home healthcare, hospice, and long-term home care. These issues include the latest developments related to the Medicare Hospice Special Focus Program, the impact of the Medicare home health payment model, Medicare Advantage (MA) claim denials in post-acute care, and increasing threats to Medicaid support. The venerable w...

en-us

30:37

1.2 Billion in Fraudulent Claims for Wound Care...

Monitor Mondays ·

2025/02/17

Evoking the age-old adage of having “skin in the game,” a Phoenix, Arizona couple last month entered a plea of guilty to one of the largest healthcare frauds in U.S. history. The couple pleaded guilty to criminal charges involving the submission of $1.2 billion in fraudulent claims to Medicare, Medicaid, and other insurers for wound care procedures. The husband-and-wife team have agreed to pay more than $600 million in restitution and face over 20 years in prison, according to famed whistlebl...

en-us

29:58

Major Challenges Facing American Hospitals Explained

Monitor Mondays ·

2025/02/10

Challenges in reimbursement, benchmarking, and quality reporting are being experienced in many American hospitals. Why is this problem arising? Our special guest during the next live edition of Monitor Mondays will have answers. Penny Jefferson, a seasoned healthcare professional who serves as the Director of Clinical Documentation Integrity (CDI) Services at the University of California at Davis Medical Center, will report on why misinterpretation of the admission types appears to be the cul...

en-us

28:24

Artificial Intelligence and Healthcare: Three...

Monitor Mondays ·

2025/02/03

Artificial intelligence (AI) is becoming as commonplace in healthcare as billing audits. It’s ubiquitous. And that is why the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to explore the intersection of AI and healthcare. So, during the next live edition of the venerable live weekly Internet broadcast, Cohen will address key concerns for compliance professionals, including Health Insurance Portability and Accountability (HIPAA) requirements, data governance, ...

en-us

28:52

Stargate Promises New Advancements in Medicine....

Monitor Mondays ·

2025/01/27

Earlier this week, in the wake of the inauguration of President Donald Trump, a major announcement was made that some hope will lead to new advances in healthcare: “Stargate,” a private venture to build in the U.S. hyperscale data centers for artificial intelligence (AI). The strategic goal is to make the United States the world’s leader in AI.Larry Ellison, founder of the relational database company Oracle, indicated that much work in this project will be focused on healthcare, including the...

en-us

30:41

Major False Claims Act Settlement Snags New York’s...

Monitor Mondays ·

2025/01/13

New York health insurer Independent Health and its former executive reached a settlement that will amount to up to $100 million with the U.S. Department of Justice (DOJ) and a whistleblower over False Claims Act allegations that they made Medicare members appear sicker than they really were to get more money from the government, a practice known as risk adjustment fraud.Betsy Gaffney, former CEO of now-defunct vendor DxID, agreed to pay $2 million to resolve allegations she helped DxID mine p...

en-us

28:43

May I have the Envelope: 2024 Healthcare Heroes to be...

Monitor Mondays ·

2024/12/16

“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...

en-us

28:41

Health Insurers in the Spotlight in the Wake of CEO...

Monitor Mondays ·

2024/12/09

Have you ever had your insurance company deny payment for your claim?Have you ever had your insurance company stall or deny a pre-authorization?How long did it take to get the authorization for the medication you’ve been using to keep yourself alive for the past few years? Was it maddening?During the next edition of Monitor Mondays, physician and attorney Dr. John K. Hall will examine the frustration that modern health insurance has become – especially in the context of the recent fatal shoot...

en-us

28:54

National Audit News Roundup

Monitor Mondays ·

2024/12/02

It’s raining recovery auditors.More denials. More grief. More lost revenue and more palpable anxiety.The seemingly unending war between payers – private and public – and providers continues unabated. The ubiquitous Two-Midnight Rule and the contentious subject of observation versus inpatient status have become an indelible part of America’s healthcare system.And that is why the producers of RACmonitor have dedicated the next live edition of the venerable Monitor Mondays Internet broadcast to ...

en-us

22:23

How E&M Code Misuse Triggered an FCA Settlement

Monitor Mondays ·

2024/11/25

$23 million: that’s the amount that the University of Colorado Health, also known as UCHealth, has agreed to pay to resolve False Claims Act allegations related to its seeking and receiving payment from federal healthcare programs for visits to its emergency departments.The university, headquartered in Aurora, was accused of falsely coding certain Evaluation & Management (E&M) claims submitted to the Medicare and TRICARE programs.Reporting the lede story during the next live edition o...

en-us

29:39

New Healthcare Survey Reveals Need for Continuous...

Monitor Mondays ·

2024/11/18

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 help you and your team as you grapple with the dynamic environment of America’s healthcare system.Broadcast segments ...

en-us

30:19

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

Monitor Mondays ·

2024/11/11

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 venerable Internet radio broadcast, Dr. Kartchner will complete his discussion as to how detailed clinical updates, ...

en-us

28:52

Denials Going from Bad to Worse

Monitor Mondays ·

2024/11/04

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 significantly higher rate than traditional Medicare even though the rule is supposed to be applied the same way in both pro...

en-us

27:30

Sex, Lies and Turmoil

Monitor Mondays ·

2024/10/28

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 storage of unsecured personally identifiable information of Medicare beneficiaries.Recognizing that it’s not only a b...

en-us

26:48

The Two-Midnight Rule: Presumption of Risk

Monitor Mondays ·

2024/10/21

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 expectation?During the next live edition of Monitor Mondays, Ben Kartchner, MD, a prominent physician advisor, w...

en-us

26:56

False Claims Act Violation: Unnecessary Drug Testing...

Monitor Mondays ·

2024/10/14

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 provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government – and to share in...

en-us

27:58

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

Monitor Mondays ·

2024/10/07

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 by no means over.The idea of imposing rebates in 340B is not a new one, and the concept has come back into prominen...

en-us

28:04

Violence in America’s Hospitals

Monitor Mondays ·

2024/09/30

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 Jefferson Health.Jones returns to his beat to continue his reporting of this issue. Among those healthcare professiona...

en-us

28:41

Whistleblower Report: Oak Street Health Agrees to...

Monitor Mondays ·

2024/09/26

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 of Justice (DOJ). Reporting the lead story during the next live edition of Monitor Mondays will be Max Wollman, a pa...

en-us

29:00

Exposing Challenges to Getting Paid by Medicare...

Monitor Mondays ·

2024/09/16

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 Federal Register for Medicare in 2024. She also alleges that some Medicare Advantage (MA) plans are not abiding by...

en-us

87 results

Similar Podcasts

Science Talk

Albert Einstein College of Medicine

五分钟心理学

柠檬心理

Daily Facts

Amalia Dupray and Montgomery Jones.

Les dents et dodo

BFMTV

Veterinary Clinical Podcasts

The Royal Veterinary College