Monitor Mondays

RACmonitor

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/

  1. 1D AGO

    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 influencing decisions behind the scenes, even when it is not clearly visible. During the next live edition of the long-running Monitor Monday, the Internet broadcast produced by RACmonitor, Sharon Easterling will explain in simple terms how AI reads the clinical record.  Unlike clinicians, AI does not understand the full story of the patient. Instead, it looks for patterns such as words, phrases, and signals, and uses those patterns to reach a conclusion. Because of this, the same record can lead to different outcomes.  Easterling, RACmonitor and Monitor Monday technology consultant, returns to the broadcast and will use a straightforward way to evaluate decisions so that conclusions remain supported, clear, and defensible, even as AI becomes more involved in the process. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney Amanda Mills will join the broadcast with his trademark segment. ·      Legislative Update: Matthew Albright, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

    30 min

  2. MAR 23

    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 $117.7 million to resolve a case involving purportedly inaccurate and untruthful diagnosis codes to increase payments.  That and other recent U.S. Department of Justice (DOJ) actions will take center stage during the next edition of Monitor Mondays, when featured speakers will weigh in on striking recent trends related to such developments. Settlements and judgments under the FCA totaled $6.8 billion in the most recent full fiscal yar, an all-time record, with 84 percent of the recoveries related to matters involving the healthcare industry.  Broadcast segments will also include these instantly recognizable features: •Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  •The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  •Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. •Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

    31 min

  3. MAR 16

    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 can you protect your facility from takebacks? How do you maintain coding excellence to remain compliant? Join this coming Monday, March 16 for the next live edition of the venerable Monitor Mondays Internet broadcast, when senior healthcare analyst Frank Cohen will describe the inner workings of autonomous coding. Cohen will also explain how to survive in today’s unforgiving audit landscape, which has become a habitat for advanced technology. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

    27 min

  4. MAR 9

    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 payers. While these systems often overlap, they originate from different authorities and serve different purposes. One governs compliance and program integrity; the other determines whether services are approved and reimbursed. As prior authorization expands and audit scrutiny intensifies, hospitals are increasingly navigating both systems at once. Understanding the distinction between regulatory documentation standards and payer-driven requirements is becoming essential for aligning clinical workflows, documentation practices, and operational strategy in today’s healthcare environment. During the next live edition of the venerable Monitor Monday, the  live Internet broadcast, senior healthcare consultant Penny Jefferson returns to the broadcast to explain what many today are calling the new face of healthcare. Broadcast segments will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

    30 min

  5. MAR 2

    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 program. In an official news release posted Thursday, CMS reported suspending $5.7 billion in suspected fraudulent Medicare payments, preventing $1.5 billion in DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) billing, revoking more than 5,500 providers’ billing privileges, and denying 122,000 claims that failed medical necessity checks. This latest news, including a nationwide DMEPOS enrollment moratorium and a $259.5 million Medicaid funding deferral, signals a decisive shift toward real-time enforcement. What does CRUSH mean for providers, revenue cycle leaders, and compliance teams? Senior healthcare consultant Penny Jefferson will be the special guest during the next live edition of the long-running news and information national podcast Monitor Mondays. Jefferson, the director of clinical documentation integrity (CDI) services for the University of California Davis Medical Center, will report on this new and developing story. The broadcast will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

    31 min

  6. FEB 23

    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 for their patients’ access to and coverage for care. What’s necessary is the need to understand the rules of the process. And Medicare Advantage plans have many of them. During the next live edition of the venerable Monitor Monday, the Internet broadcast, Richelle Marting, a healthcare attorney, and certified coder, will help you understand when and how Medicare Advantage plans can use prior authorizations for the critical protections you need to know to advocate for patient care. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Matthew Albright of Zelis, will report on current healthcare legislation.

    30 min

  7. FEB 16

    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 Two-Midnight Rule.”  However, there is more to consider than compliance with 42 CFR 412.3.  Federal regulations also state Medicare Advantage organizations must comply with Traditional Medicare laws including payment criteria for inpatient admissions at 42 CFR 422.101(b)(2). So the burning question remains: Is CMS disregarding pertinent regulations that could nullify Aetna’s policy? During the next live edition of the venerable Monitor Monday, the Internet broadcast, Cheryl Ericson, senior director of clinical policy and education for the Brundage Group, will address this apparent contradiction. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. ·      Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

    30 min

  8. FEB 9

    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 omissions and errors in submitted claims. Then there are seemingly contradictory rules from the Centers for Medicare & Medicaid Services (CMS). It’s little wonder that providers are treading cautiously as they look to thread the needle of compliance. This coming Monday, the venerable Monitor Mondays broadcast will present a cadre of the sharpest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – just here. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. ·      Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.

    26 min
See All (394)

About

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/

Information

  • Creator
    RACmonitor
  • Years Active
    2018 - 2026
  • Episodes
    394
  • Rating
    Clean
  • Copyright
    © 2026 Monitor Mondays
  • Show Website
    Monitor Mondays

You Might Also Like