Monitor Mondays
RACmonitor
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About This Podcast
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/
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Recent Episodes
S14E684 Recent Lawsuit: Racial Concordance in Healthcare Takes Center Stage
At the heart of a recent lawsuit filed by a physician is whether the medical profession’s understanding and practice of racial concordance is legally defensible.“Find-A-Black-Doctor” has served as a…
S14E683 AI and Auditing: Major Compliance Risks
It’s that bright new shiny object few seem to manage to resist: artificial intelligence (AI).Here at RACmonitor and Monitor Mondays, we have been reporting on how this disruptive technology has been…
S14E682 Surge in False Claims Act Violations Triggers New DOJ Initiative
Introducing FOCUS (Fraud Oversight through Careful Use of Statistics). The U.S. Department of Justice (DOJ) has launched a new initiative in response to the surge in False Claims Act qui tam filings…
S14E681 When Algorithms Audit Algorithms
Healthcare compliance has entered the machine-learning era, and most organizations have not yet noticed. Providers are using artificial intelligence (AI) to generate documentation, surface…
S14E680 Developing Story: Updating Sepsis Terminology in ICD-10-CM
Documenting and coding sepsis has challenged virtually everyone in healthcare ever since Sepsis-3 redefined the condition in 2016 as a “life-threatening organ dysfunction due to a dysregulated host…
S14E679 SCOTUS Decision on Colorado “Conversion Therapy” Ban Leaves Much Left to Determine
The recent U.S. Supreme Court decision in Chiles v. Salazar doesn’t really close the case – but it also doesn’t really leave it open. The 8-1 decision, in which the nation’s highest court ruled that…
S14E678 A Close-Up Look at Healthcare AI “Sherpas”
Artificial intelligence (AI) is clearly here to stay – it’s now an integral part of healthcare. From coding and clinical validation to payer denials and appeals, AI is often a form of power upon…
S14E677 EXCLUSIVE: Huge Loophole Has Insulated Medicare Appeals
When the U.S. Supreme Court overturned Chevron deference, it promised to restore judicial independence and limit agency overreach. But in Medicare administrative proceedings, that promise remains…
S14E676 Medical Double Dose: A Paradox on Doctor’s Day
National Doctor’s Day will bring a double whammy this coming Monday when the venerable Monitor Monday continues its recognition of the occasion with a pair of featured speakers: Drs. Drew Updike and…
S14E675 Understanding AI Interpretation in Healthcare
Artificial intelligence (AI) is becoming part of how clinical documentation is reviewed across healthcare, from coding and clinical validation to payer denials and appeals. In many cases, AI is…
S14E674 Aetna Latest to Acquiesce Amid FCA Allegations
Aetna is just the latest in a long list of healthcare entities to settle False Claims Act (FCA) allegations with a massive settlement.The insurer, one of the nation’s largest, recently agreed to pay…
S14E673 Autonomous Coding: A New Reality
Imagine machine learning and natural language processing deployed to audit claims.Today, it’s the new reality.Autonomous coding is dramatically altering the treacherous auditing landscape. So, how…
S14E672 Lesson Learned: Navigating the Ever-Expanding Scope of Prior Authorization
Healthcare documentation is no longer written for a single audience. Today, the medical record must simultaneously meet federal regulatory requirements and the coverage expectations of individual…
S14E671 CMS Launches CRUSH: A New Anti-Fraud Program
The Centers for Medicare & Medicaid Services (CMS) has launched a new initiative titled Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).CRUSH is a sweeping fraud prevention…
S14E670 Medicare Advantage and Prior Authorizations: The Good. The Bad. The Ugly.
Prior authorizations among Medicare Advantage plans have drawn criticism and concern from patients, providers, lawmakers, and regulators. But hospitals and doctors are uniquely positioned to advocate…
S14E669 Did CMS Draw the Right Conclusion about Aetna’s Severity Policy?
In a January 28 article, Dr. Ronald Hirsch verified that the Centers for Medicare and Medicaid Services (CMS) “has no problem” with the Aetna Severity Payment policy because it “meets the…
S14E668 Reign of Terror: Special Audit Report
It’s raining RACs.The Recovery Auditor Contractors (RACs), together with an alphabet soup of other private and public auditors, are coming down hard on hospitals and physician practices, looking for…
S14E667 Docs Take Another Financial Hit
There was a time when Relative Value Units (RVUs) felt like a stable currency – something you and others could take to the bank. That was then. This is now.Then, productivity could be measured,…
S14E666 $556 million False Claims Settlement Rattles Many in Healthcare
While many of you were enjoying the holidays, Kaiser Permanente wasback in the news. This time, another whistleblower case which resulted inan amazing $556 million settlement to resolve allegations…
S14E665 CMS Blocks Gender Affirmative Care
The Centers for Medicare & Medicaid Services (CMS) will block hospitals from performing certain interventions that are intended to change a child’s physical appearance to align an asserted sex…
Frequently Asked Questions
Monitor Mondays has published 403 episodes since January 2018, covering topics in Education, Government.
Monitor Mondays is currently highly active with new episodes weekly. Average episode length is 30m.
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