Monitor Mondays

RACmonitor
  • 4.5 (23)
  • EDUCATION
  • UPDATED WEEKLY

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. 11H AGO

    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 response to infection.” Meanwhile, ICD-10-CM still maintains the older Sepsis-2 language of sepsis (SIRS/Systemic Inflammatory Response Syndrome due to infection, without organ dysfunction) and severe sepsis (sepsis that does result in organ dysfunction). During the next live edition of Monitor Monday, Dr. James S. Kennedy will report on efforts currently underway to address the recent Centers for Disease Control and Protection (CDC) proposal to align ICD-10-CM to Sepsis-3/Phoenix terminology, and to introduce new codes for “impending sepsis,” also known as pre-sepsis: a morbid continuum between a localized infection with and without Sepsis-3/Phoenix-defined sepsis . Dr. Kennedy is expected to solicit assistance from Monitor Mondays listeners toward a reasonable solution. 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.

    29 min

  2. APR 27

    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 a Colorado ban on so-called “conversion therapy” for juveniles was unconstitutional, is subtle, complex, and unnerving; the American Psychological Association issued a statement noting that it was “deeply concerned” over it.  The case relates to conversion therapy as talk therapy, specifically related to gender identity and First Amendment rights. But the decision only remands the matter for further review by the Tenth Circuit, thus leaving the issue essentially undecided.  Is this just more judicial “Calvinball” – the game highlighted in the classic comic strip Calvin and Hobbes, in which the rules are made up on the fly – or is the Court simply assuring another bite at this apple? Our own Physician and attorney Dr. John K. Hall will explore these questions and look for answers during the next edition of Monitor Mondays. 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.

    25 min

  3. APR 20

    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 which decisions are made by providers, payers, and auditors. You and your team should be aware of the several so-called healthcare “sherpas” available to interpret vast amounts of AI-generated data, among them Grok 4: an AI-powered chatbot solution developed by Elon Musk’s xAi, which is integrated with the X (formerly Twitter) social network. As we have before, our producers invited RACmonitor Investigative Reporter Edward M. Roche to investigate AI and its sherpas, including Grok 4, during the next edition of the long-running Monitor Mondays Internet broadcast, this coming Monday, April 20, at 10 a.m. EST. 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. APR 13

    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 unfulfilled.  Tune in to the next upcoming live edition of Monitor Mondays, when senior healthcare analyst Frank Cohen will report on his surprise when an Administrative Law Judge issued a categorical ruling: Loper Bright simply does not apply to the proceedings of the Office of Medicare Hearings and Appeals (OMHA). Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Dr. Jennifer Weinberg will be making her 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 will report on current healthcare legislation.

    30 min

  5. APR 6

    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 Christopher Boyle. The day of recognition took place on March 30, the date when Eudora Brown would place flowers on the graves of late physicians, starting in 1933. Historians are quick to note that the date also commemorates the first use of anesthesia for surgery. Fast forward to Monday, April 6, 2026: that’s when Drs. Updike and Boyle will not only be recognized for their service by Monitor Mondays, but featured as speakers. 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.

    34 min

  6. MAR 30

    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

  7. 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

  8. 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
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Ratings & Reviews

4.5
out of 5
23 Ratings

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
    399
  • Rating
    Clean
  • Copyright
    © 2026 Monitor Mondays
  • Show Website
    Monitor Mondays

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