Monitor Mondays
By RACmonitor
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Episodes: 422
Description
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://medlearn.com/racmonitor/podcasts/
| Episode | Date |
|---|---|
|
Feds Initiate $25 Million Whistleblower Program
|
Oct 26, 2026 |
|
Compliance: The Underpinnings of ACDIS
|
Oct 19, 2026 |
|
National Case Management Week: The Inside Story of What’s Driving Outcomes
|
Oct 12, 2026 |
|
DOJ Announces $385 Million Settlement to Resolve False Claims Allegations over Abbott Laboratories Baby Formula
|
Oct 05, 2026 |
|
Convicted: The Cases Every Compliance Leader Should Know About Now
|
Sep 28, 2026 |
|
Complicated Compliance and Auditing That’s More Than Skin Deep
|
Sep 21, 2026 |
|
“Faster than a Speeding Bullet:” The Immediate Compliance Challenge Created by AI
|
Sep 14, 2026 |
|
Purging the Surge of Data Miners: A New FCA Program from DOJ
|
Aug 31, 2026 |
|
Gender Affirming Care (CMS-2451-F): Still Proposed
|
Aug 24, 2026 |
|
Buffeted, Badgered, Bruised and Bleeding: The Battered 340B Drug Reforms
|
Aug 17, 2026 |
|
Latest Privacy Issue: AI-Powered Wearables
|
Aug 10, 2026 |
|
The One Note Samba: DOJ Data Sharing
|
Aug 03, 2026 |
|
Healthcare Today: Status Quo Bias
|
Jul 27, 2026 |
|
The Latest Compliance Trap: Medicare Cost Reports
|
Jul 20, 2026 |
|
Preventing Denials: The Role of Facility-Based Clinical Definitions
|
Jul 13, 2026 |
|
Behavioral Health: Avoiding Common Pitfalls
|
Jul 06, 2026 |
|
Avoiding the Next Claim Denial
|
Jun 29, 2026 |
|
Seeking Compliance Across the Revenue Cycle
|
Jun 22, 2026 |
|
Who will Blink First? 340B Health at Center Stage as Controversy Continues
|
Jun 15, 2026 |
|
Recent Lawsuit: Racial Concordance in Healthcare Takes Center Stage
|
Jun 08, 2026 |
|
AI and Auditing: Major Compliance Risks
|
Jun 01, 2026 |
|
Surge in False Claims Act Violations Triggers New DOJ Initiative
|
May 18, 2026 |
|
When Algorithms Audit Algorithms
|
May 11, 2026 |
|
Developing Story: Updating Sepsis Terminology in ICD-10-CM
|
May 04, 2026 |
|
SCOTUS Decision on Colorado “Conversion Therapy” Ban Leaves Much Left to Determine
|
Apr 27, 2026 |
|
A Close-Up Look at Healthcare AI “Sherpas”
|
Apr 20, 2026 |
|
EXCLUSIVE: Huge Loophole Has Insulated Medicare Appeals
|
Apr 13, 2026 |
|
Medical Double Dose: A Paradox on Doctor’s Day
|
Apr 06, 2026 |
|
Understanding AI Interpretation in Healthcare
|
Mar 30, 2026 |
|
Aetna Latest to Acquiesce Amid FCA Allegations
|
Mar 23, 2026 |
|
Autonomous Coding: A New Reality
|
Mar 16, 2026 |
|
Lesson Learned: Navigating the Ever-Expanding Scope of Prior Authorization
|
Mar 09, 2026 |
|
CMS Launches CRUSH: A New Anti-Fraud Program
|
Mar 02, 2026 |
|
Medicare Advantage and Prior Authorizations: The Good. The Bad. The Ugly.
|
Feb 23, 2026 |
|
Did CMS Draw the Right Conclusion about Aetna’s Severity Policy?
|
Feb 16, 2026 |
|
Reign of Terror: Special Audit Report
|
Feb 09, 2026 |
|
Docs Take Another Financial Hit
|
Feb 02, 2026 |
|
$556 million False Claims Settlement Rattles Many in Healthcare
|
Jan 26, 2026 |
|
CMS Blocks Gender Affirmative Care
|
Jan 12, 2026 |
|
The Whistleblower Update
|
Dec 15, 2025 |
|
The Fatal Blow: “Statistically Valid Extrapolation”
|
Dec 08, 2025 |
|
The Feds Blow the Whistle: A $45 Million Wound Care Settlement
|
Dec 01, 2025 |
|
Providers Appear More Aggressive in Defending Revenue
|
Nov 24, 2025 |
|
New Audit Traps Revealed in the 2026 Medicare Physician Fee Schedule
|
Nov 17, 2025 |
|
New Sepsis Definition Could Help You Achieve Denial Avoidance
|
Nov 10, 2025 |
|
DME Supplier Pays $37 Million to Resolve FCA Allegations
|
Nov 03, 2025 |
|
A New Drug Crisis Soon Facing American Hospitals
|
Oct 27, 2025 |
|
The Lowdown on the Shutdown
|
Oct 20, 2025 |
|
During Case Management Week: Unpacking Healthcare Cuts
|
Oct 13, 2025 |
|
Court Vacates RAVD 2023 Final Rule
|
Oct 06, 2025 |
|
Into a Rabbit Hole: Medical Loss Ratio Fraud Detected in Managed Care Program
|
Sep 29, 2025 |
|
Whistleblowers Bring Total Knee Replacement DME to its Knees
|
Sep 22, 2025 |
|
When Whistleblowers Can’t Whistle
|
Sep 15, 2025 |
|
Audit Alert: Who’s Auditing AI?
|
Sep 08, 2025 |
|
Is the UPIC Fraud Prevention System Broken?
|
Aug 25, 2025 |
|
A Reign of Terror for Providers
|
Aug 18, 2025 |
|
Invalid Prescriptions Trigger CVS Omnicare Whistleblower Lawsuit
|
Aug 11, 2025 |
|
340B: Fighting Back Against Big Pharma
|
Aug 04, 2025 |
|
The Changing Audit Landscape
|
Jul 28, 2025 |
|
An OPPS Oops?
|
Jul 21, 2025 |
|
Medicaid Madness
|
Jul 14, 2025 |
|
Chevron Deference: What Difference Has a Year Made?
|
Jul 07, 2025 |
|
Breaking News: A Major Regulatory Shift
|
Jul 07, 2025 |
|
Fraud, Waste, and Abuse: The 2025 Triple Crown
|
Jun 23, 2025 |
|
Compliance Quicksand: Sepsis
|
Jun 16, 2025 |
|
Medicaid Madness
|
Jun 09, 2025 |
|
Whistleblower Update: Rheumatologist Sentenced to Jail, Must Forfeit Maserati and Other Possessions
|
Jun 02, 2025 |
|
Tariffs: The Impact on Drugs
|
May 19, 2025 |
|
Speak No Evil: Asking Docs to Weigh In Became a $202 Million False Claims Act Settlement
|
May 12, 2025 |
|
340B In the Crosshairs
|
May 05, 2025 |
|
Audit Alert: Immigration in Healthcare
|
Apr 28, 2025 |
|
FY 2026 IPPS: Hospital Strategy for Risk Adjustment, Equity, and Reimbursement
|
Apr 21, 2025 |
|
HHS, CMS Latest Apparent Battlegrounds for Social Wars Being Waged by Trump Administration
|
Apr 14, 2025 |
|
Caught in the Crossfire: How to Avoid Pay-and-Chase Enforcement Tactics
|
Apr 07, 2025 |
|
Wound Care: An Open Source for Audits
|
Mar 31, 2025 |
|
Advanced Beneficiary Notice: A Doctors’ Day Observance
|
Mar 24, 2025 |
|
At the Intersection of CDI and the False Claims Act
|
Mar 17, 2025 |
|
Why Complications are Complicated
|
Mar 10, 2025 |
|
DEVELOPING STORY: No Public Comment Allowed for HHS Rulemaking
|
Mar 03, 2025 |
|
Hot Off the Presses: Latest Issues Impacting Medicare Home Health Care, Hospice, and Medicaid Services
|
Feb 24, 2025 |
|
1.2 Billion in Fraudulent Claims for Wound Care Procedures
|
Feb 17, 2025 |
|
Major Challenges Facing American Hospitals Explained
|
Feb 10, 2025 |
|
Artificial Intelligence and Healthcare: Three Critical Areas You Need to Know About
|
Feb 03, 2025 |
|
Stargate Promises New Advancements in Medicine. Compliance Unclear
|
Jan 27, 2025 |
|
Major False Claims Act Settlement Snags New York’s Independent Health
|
Jan 13, 2025 |
|
May I have the Envelope: 2024 Healthcare Heroes to be Revealed
|
Dec 16, 2024 |
|
Health Insurers in the Spotlight in the Wake of CEO Slaying
|
Dec 09, 2024 |
|
National Audit News Roundup
|
Dec 02, 2024 |
|
How E&M Code Misuse Triggered an FCA Settlement
|
Nov 25, 2024 |
|
New Healthcare Survey Reveals Need for Continuous Financial Risk Monitoring
|
Nov 18, 2024 |
|
Simplifying the Two-Midnight Rule: Simple as 1, 2, 3
|
Nov 11, 2024 |
|
Denials Going from Bad to Worse
|
Nov 04, 2024 |
|
Sex, Lies and Turmoil
|
Oct 28, 2024 |
|
The Two-Midnight Rule: Presumption of Risk
|
Oct 21, 2024 |
|
False Claims Act Violation: Unnecessary Drug Testing Flags Feds
|
Oct 14, 2024 |
|
340B Drug Rebates: Old Debate Revived, But Shot Down
|
Oct 07, 2024 |
|
Violence in America’s Hospitals
|
Sep 30, 2024 |
|
Whistleblower Report: Oak Street Health Agrees to Pay $60M to Resolve Alleged False Claims Act Liability in Medicare Advantage Patient Recruitment Scheme
|
Sep 26, 2024 |
|
Exposing Challenges to Getting Paid by Medicare Advantage
|
Sep 16, 2024 |
|
How to Ensure Correct Inpatient Status
|
Sep 09, 2024 |
|
New Study Reveals America’s Big Hang-up with Healthcare
|
Aug 26, 2024 |
|
Federal Officials Announce Medical Relief in Wake of Hurricane
|
Aug 19, 2024 |
|
There’s a New Sheriff in Town: New DOJ Program Intends to Snare Even More FCA Fraudsters
|
Aug 12, 2024 |
|
FY 2025 IPPS: The Clinical Report
|
Aug 05, 2024 |
|
“Do the Crime, Pay the Fine:” DaVita to Pay$34 million to Resolve Allegations of Illegal Kickbacks
|
Jul 29, 2024 |
|
End of the Road for the ALJs?
|
Jul 22, 2024 |
|
Handle with Care: Taking Steps for Safe Transitions
|
Jul 15, 2024 |
|
No More Chevron? What Happens Next?
|
Jul 08, 2024 |
|
Special Alert: DOJ Cracks Down on Nearly 200 Involved in Major Healthcare Fraud Schemes
|
Jul 01, 2024 |
|
How a Different Type of Whistleblower Created a Lesson Worth Learning
|
Jun 24, 2024 |
|
The Human Touch at the Intersection of Artificial Intelligence and Denied Claims
|
Jun 17, 2024 |
|
OIG On the Prowl: Semi-Annual Report to Congress
|
Jun 10, 2024 |
|
Jail Time, or Hefty Fine?
|
Jun 03, 2024 |
|
New Medical Technologies: Are They Audit-Proof?
|
May 20, 2024 |
|
Healthcare Whistleblower Roundup: Recent Settlements Reach Nearly $10 Million
|
May 13, 2024 |
|
The AI Arms Race in Healthcare Auditing: Handicapping Winners and Losers
|
May 06, 2024 |
|
The Value of Peer-to-Peer Discussion
|
Apr 29, 2024 |
|
The Two-Midnight Rule: Navigating Treacherous Medicare Currents
|
Apr 22, 2024 |
|
Defense Strategies Against AI Audits
|
Apr 15, 2024 |
|
Medicare Advantage “Schemes” in the DOJ Crosshairs
|
Apr 08, 2024 |
|
Whistleblower Update: $300 Million in Alleged Fraud
|
Apr 01, 2024 |
|
How to Achieve a Clear Vision for Hospital Price Transparency
|
Mar 25, 2024 |
|
The Fix is in: Hospital Price Transparency Rule
|
Mar 18, 2024 |
|
Empowering the Bedside Physician to Lower Observation Rates
|
Mar 11, 2024 |
|
Hospital Price Transparency Rule: An Important Update
|
Mar 04, 2024 |
|
Updated Episode | Chevron Deference: What Happens if There’s No Deference?
|
Mar 04, 2024 |
|
Artificial Intelligence: Examining Promises, Skepticism, and Ethical Implications
|
Feb 19, 2024 |
|
What’s the Score with Your Physicians? Don’t Miss MIPS
|
Feb 13, 2024 |
|
How CERT Data Is Used to Target Providers
|
Feb 05, 2024 |
|
How to Protect Your Facility from CERT Audits
|
Jan 29, 2024 |
|
U.S. Forced to Comply with International Healthcare Law: Fact or Fiction?
|
Jan 22, 2024 |
|
Look Out, Look Ahead
|
Jan 08, 2024 |
|
2023 Healthcare Heroes to be Revealed
|
Dec 04, 2023 |
|
America’s Healthcare System: A Gordian Knot
|
Nov 27, 2023 |
|
At the Intersection of AI and Medical Record Audits
|
Nov 20, 2023 |
|
False Claims Act Roundup: 2023 Was a Very Good Year for the Feds
|
Nov 13, 2023 |
|
The Two-Midnight Rule Remains Too Confounding
|
Nov 06, 2023 |
|
Violence in America’s Hospitals
|
Oct 30, 2023 |
|
Lowering Prices, Increasing Supplies of Prescription Drugs
|
Oct 23, 2023 |
|
When it Rains, it Pours: Understanding New Compliance Risks
|
Oct 16, 2023 |
|
The Future of Cancer Treatment is Now: But Will Payers Pay?
|
Oct 09, 2023 |
|
Does the Two-Midnight Rule Apply to MA Plans?
|
Oct 02, 2023 |
|
Peeking Behind the Curtain: AI and Claims Auditing
|
Sep 25, 2023 |
|
The Medicare Report Card: Assessing Areas for Major Reform
|
Sep 18, 2023 |
|
Like Autumn Leaves, RAC Audits Keep Falling
|
Sep 11, 2023 |
|
Assessing the Impact of Financial Woes Facing America’s Healthcare Providers
|
Aug 28, 2023 |
|
Physician Advisors: Revenue Drag or Stimulant?
|
Aug 21, 2023 |
|
What’s So Smart About Smart Hospitals?
|
Aug 14, 2023 |
|
FY 2024 IPPS Final Rule: Looking Under the Hood for Hazards
|
Aug 07, 2023 |
|
Proposed Expansion of Medicaid RACs Includes Focus on Managed Care Payments
|
Jul 31, 2023 |
|
New Developments for Defeating Statistical Extrapolations Revealed
|
Jul 25, 2023 |
|
$9 Billion Refund to 340B Hospitals at Risk
|
Jul 17, 2023 |
|
Enforcement and Penalties, Guardrails and Risks: Understanding the 21st Century Cures Act
|
Jul 10, 2023 |
|
The Big Worry. The Big Unwind: Medicaid Disenrollment Keeps Rolling Along
|
Jun 26, 2023 |
|
How Suffocating Regulations Are Leading to Smart Hospitals
|
Jun 19, 2023 |
|
How Staffing Shortages Increase Audits
|
Jun 12, 2023 |
|
Running Afoul of Federal Regulations
|
Jun 05, 2023 |
|
Smart Strategies to Avoid Denials of SNF Transfers
|
May 22, 2023 |
|
How to Avoid Managed Care Denials for SNF Transfers
|
May 15, 2023 |
|
Compliance Risk and Revenue Loss: Practicing without Privileges
|
May 08, 2023 |
|
Utilization and Billing: Reconciling Conflicts
|
May 01, 2023 |
|
The False Claims Act: Will it Live to See Another Day?
|
Apr 24, 2023 |
|
Confronting Artificial Intelligence: Healthcare’s Next Major Disruptor
|
Apr 17, 2023 |
|
The Ins and Outs of Procedures: Confronting the CMS Inpatient-Only List
|
Apr 10, 2023 |
|
Reintroducing the Three-Midnight Rule: It’s Back, and it’s a Problem
|
Apr 03, 2023 |
|
15 Million Enrollees Soon to be Missing: The Unwinding of Medicaid’s Continuous Enrollment
|
Mar 27, 2023 |
|
Reverse False Claims: This Could Happen to You
|
Mar 20, 2023 |
|
The Anatomy of Fraud: Kickbacks and 64,000 False Claims
|
Mar 13, 2023 |
|
National Doctors Day Recognizes Physicians as Gatekeepers
|
Mar 06, 2023 |
|
FCA Fraud Against U.S. Tops $2.2 Billion
|
Feb 27, 2023 |
|
Crossing the Compliance Line: Worth Less or Worthless?
|
Feb 20, 2023 |
|
To Be, Or Not to Be: Reconciling Inpatient Status
|
Feb 13, 2023 |
|
The Nationwide Audit News Roundup
|
Feb 06, 2023 |
|
Mary's Bookclub: Respiratory Therapy All Access Pass
|
Feb 01, 2023 |
|
Exclusive: Never-Before-Released HCC Data Reveals Possible Link to Under/Over Coding
|
Jan 30, 2023 |
|
Do No Harm: A Quarter of Medicare Patients Experience Adverse Events, per the OIG
|
Jan 23, 2023 |
|
Mary's Bookclub: Nuclear Medicine All Access Pass
|
Jan 12, 2023 |
|
Nationwide Dragnet: An Update on Auditing
|
Jan 09, 2023 |
|
Mary's Bookclub: Infusion & Injection All Access Pass
|
Dec 14, 2022 |
|
Too Big to Fail: Part II
|
Dec 12, 2022 |
|
Medicare Audits: The Hunting Game
|
Dec 05, 2022 |
|
Mary's Bookclub: Comprehensive Cardiology All Access Pass
|
Nov 30, 2022 |
|
Eating Their Own: OIG Investigating Medicare Contractors and CMS
|
Nov 28, 2022 |
|
Swimming Among Sharks in a Sea of Turmoil: 2022 Audit Landscape
|
Nov 21, 2022 |
|
Mary's Bookclub: Ultrasound Coder
|
Nov 16, 2022 |
|
Winds of Change in the South: No Jubilee with Cotiviti
|
Nov 14, 2022 |
|
2023 Medicare Physician Fee Schedule Final Rule: Telehealth Services Post-COVID-19
|
Nov 07, 2022 |
|
Collateral Consequences of Medicare Audits
|
Oct 31, 2022 |
|
Exclusive Report: Winds of Change Blowing for Medicare Advantage Plans
|
Oct 24, 2022 |
|
The Tables Are Turning: OIG Sets Sights on Medicare Advantage DRG Validation Denials
|
Oct 17, 2022 |
|
Mary's Bookclub: Nuclear Medicine & PET Coder
|
Oct 12, 2022 |
|
Exclusive: Some Extrapolation Estimates Vacated
|
Oct 10, 2022 |
|
False Claims Act: Biogen to Pay $900 Million: Whistleblower Gets $250 Million
|
Oct 03, 2022 |
|
Beware: Enforcement of the Hospital Price Transparency Rule
|
Sep 26, 2022 |
|
Mary's Bookclub: CT/MR Coder
|
Sep 21, 2022 |
|
Medicare: The New Drug Price Negotiator
|
Sep 19, 2022 |
|
Medical Necessity: The Necessity of Defining the Dilemma
|
Sep 12, 2022 |
|
Mary's Bookclub: Peripheral & Cardiology Coder
|
Sep 01, 2022 |
|
Medicare Advantage: OIG Warns: Don’t Deny Payments
|
Aug 29, 2022 |
|
Medicare Telehealth: The Perils of Fraud and Abuse
|
Aug 22, 2022 |
|
The Unusual Autopsy You Need to Hear
|
Aug 15, 2022 |
|
False Claims Act: Whistleblower Blows the Whistle on Charity Donation
|
Aug 08, 2022 |
|
Mary's Bookclub: Essentials of Interventional Radiology Coding
|
Aug 03, 2022 |
|
The UPICs: The Mean, the Bad and the Ugly
|
Aug 01, 2022 |
|
Recent Supreme Court Decision Likely to Rattle Healthcare
|
Jul 25, 2022 |
|
Too Big to Fail: Perception of Payer Infallibility
|
Jul 18, 2022 |
|
Mary's Bookclub: Cardiac Rhythm Management Coder
|
Jul 13, 2022 |
|
What’s the Missing Ingredient in Medicare Audits?
|
Jul 11, 2022 |
|
Front and Center: Medicare Advantage Audits, Medical Necessity to Ensure Payments, and the Two-Midnight Rule
|
Jul 06, 2022 |
|
Mary's Bookclub: Coding Essentials for Laboratories
|
Jun 29, 2022 |
|
Medicare Auditing Run Amok
|
Jun 27, 2022 |
|
Fighting the Rising Tide of Claim Denials: A Physician Speaks Out
|
Jun 20, 2022 |
|
Mary's Bookclub: Coding Essentials for Infusion & Injection Therapy Services
|
Jun 15, 2022 |
|
Discovery of Nearly $3 Billion in Medicare and Medicaid Errors
|
Jun 13, 2022 |
|
National Audit Roundtable: The Curse of Condition Code 44
|
Jun 06, 2022 |
|
Mary's Bookclub: Coding Essentials for Respiratory Therapy/ Pulmonary Function
|
Jun 01, 2022 |
|
The Continuing Saga of Condition Code 44
|
May 23, 2022 |
|
Big Pharma, Big Problems: 340B Hospitals Impacted
|
May 16, 2022 |
|
Audit Roundup: Broadcast 500
|
May 09, 2022 |
|
The Problem List
|
May 02, 2022 |
|
Hospice in the Crosshairs: Multiple Auditors are Piling on
|
Apr 25, 2022 |
|
Learn How to Relieve the Stress: Observation Volumes Plaguing Hospitals
|
Apr 18, 2022 |
|
Observation Volumes Continue to Stress Hospitals
|
Apr 11, 2022 |
|
Front and Center: Payer Contracts and 2022 Audits on Implantable Device Credits
|
Apr 04, 2022 |
|
Uncovering Auditors’ Flawed Methodologies and Calculations
|
Apr 04, 2022 |
|
Emerging New Audit IPO Trap: Technical Denials
|
Mar 28, 2022 |
|
Auditing Gone Awry: A National News Roundup
|
Mar 21, 2022 |
|
National Audit News Roundup
|
Mar 14, 2022 |
|
Prior Authorizations: Problems When in the Wrong Hands
|
Mar 07, 2022 |
|
The Enigma – The Case of Richard Bagnall
|
Feb 28, 2022 |
|
“Significant Enforcement” Coming Soon
|
Feb 21, 2022 |
|
Front and Center: Medicare Advantage Audits, Spinal Procedures and 2022 IPO List
|
Feb 21, 2022 |
|
Front and Center: Shared Billing, No Surprises Act & the PEPPER
|
Feb 16, 2022 |
|
Drug Manufacturers Imposing Unlawful Limits on 340B Discounts
|
Feb 14, 2022 |
|
Nationwide Audit Dragnet
|
Feb 07, 2022 |
|
Medicare Auditors Caught Double-Dipping
|
Jan 31, 2022 |
|
Mandate Madness: On Again, Off Again
|
Jan 24, 2022 |
|
Reconciling Audits at the Intersection of Health and Health Equity
|
Jan 17, 2022 |
|
2022: Look Out, Look Ahead
|
Jan 10, 2022 |
|
The Audit Roundup: Who’s at Risk and Why
|
Dec 13, 2021 |
|
You’re an Audit Target: Special Audit Deflection Report
|
Dec 06, 2021 |
|
Resisting Medicare Advantage Bullies
|
Nov 29, 2021 |
|
A Tsunami of Medicare Audits
|
Nov 22, 2021 |
|
Shooting Fish in a Barrel: More Audits Coming as CMS Releases Flurry of New Rules
|
Nov 15, 2021 |
|
Never-Before-Revealed Secrets: How Auditors’ Bias Works Against Providers (Part I)
|
Nov 08, 2021 |
|
Open Season on Providers: Beware of the Land Mines
|
Nov 01, 2021 |
|
Audit News Roundup: Open Season on Providers
|
Oct 25, 2021 |
|
The Surprising Truth about the No Surprises Act
|
Oct 18, 2021 |
|
Beware: Inpatient Short Stays in the Crosshairs
|
Oct 11, 2021 |
|
Auditors Gone Wild: Rampant Fraud Reported with Medicare Advantage
|
Oct 04, 2021 |
|
Prepare Now Audit Frenzy Amid Hospitals Executing Crisis Standards of Care
|
Sep 27, 2021 |
|
Clinical Validation Denials: No Longer Uncommon, Definitely Unwelcomed amid Rampant Auditing
|
Sep 20, 2021 |
|
National Healthcare Audit Roundup: Sutter Health Hit with $90 Million FCA Settlement
|
Sep 13, 2021 |
|
National Regulatory and Audit Review: Risk of Audits for E&M Codes
|
Aug 30, 2021 |
|
UnitedHealth Under Fire
|
Aug 23, 2021 |
|
Observation versus Inpatient Divide Heralds Surge in Denials and Audits
|
Aug 16, 2021 |
|
Spike in Audit Activity Sets Off Alarm Bells: A Regulatory News Update
|
Aug 09, 2021 |
|
Audit and Regulatory News Roundup: A New Surge in Post-Pandemic Audits
|
Aug 02, 2021 |
|
Law and Order: Post-Pandemic Audits
|
Jul 26, 2021 |
|
Rampant RACs: Auditor Industry Profiting at Providers’ Expense
|
Jul 19, 2021 |
|
Battle Lines Have Been Drawn: Saving 340B Discounts
|
Jul 13, 2021 |
|
A Cautionary Tale: Submitting a Higher-Weighted DRG
|
Jun 28, 2021 |
|
Avoid this Top 100 Hospital List
|
Jun 21, 2021 |
|
UnitedHealthcare Poised to Deny ED Claims
|
Jun 14, 2021 |
|
Quality Audits and Malpractice Suits: How 2021 E&M Guidelines Raise Medical/Legal Issues
|
Jun 07, 2021 |
|
What Happened to the ALJ Logjam?
|
May 24, 2021 |
|
Audit Nation: The Growing Impact of Claims Auditing on Healthcare
|
May 17, 2021 |
|
Audit and Regulatory News Roundup: OIG Audits Latest Development
|
May 10, 2021 |
|
The Perpetual Appeals Machine: The ALJs and Medicare Appeals Council
|
May 03, 2021 |
|
Knock, Knock. Who’s There? OIG Warns of COVID-19 Scammers
|
Apr 26, 2021 |
|
Blame the RACs for the ALJ Backlog
|
Apr 19, 2021 |
|
Aging Bridges, Road and Patients: Infrastructure Pitch Comes with a Human Touch
|
Apr 12, 2021 |
|
Facing a Fourth Wave: COVID-19 Update
|
Apr 05, 2021 |
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Appealing Ridiculous DRG Denials: Rearranging Deck Chairs on the Titanic?
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Mar 29, 2021 |
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National Regulatory and Audit News Update
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Mar 22, 2021 |
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Novel Legal Approaches to Defend Audits: Listen and Learn
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Mar 15, 2021 |
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Bed Hijacking: Outpatients Assigned to Inpatient Beds
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Mar 08, 2021 |
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Regulatory News Roundup: Major Changes Underway by the New Administration
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Mar 01, 2021 |
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New Revelations Emerge Illuminating Misinterpretations of Condition Code 44
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Feb 22, 2021 |
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It’s All About Change: MCG and InterQual
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Feb 15, 2021 |
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Exclusive: Medical Device Credits in OIG Crosshairs
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Feb 08, 2021 |
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Billions in Overpayments Levied Against Providers by CMS; Uncovering Flaws in Methodology
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Feb 01, 2021 |
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COVID-19 News Update – The Mask Mandate
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Jan 25, 2021 |
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Increases in Physician Payments Also Means Greater Recoupment
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Jan 18, 2021 |
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2021: Look Out, Look Ahead
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Jan 11, 2021 |
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Regulatory News Roundup: A Special 60-Minute Open Door Forum
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Dec 07, 2020 |
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$6.38 Million Medicare Advantage Whistleblower Settlement
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Nov 30, 2020 |
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COVID-19: Coronavirus and Compliance A Special 60-Minute Open Door Forum
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Nov 23, 2020 |
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Triaging Denials: Emphasize Preparation, Don’t Panic
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Nov 16, 2020 |
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Avoiding a Major Healthcare Crisis: The Need to Bring Back Post-Acute Waivers
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Nov 09, 2020 |
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Civil Monetary Penalties for Paying Ransomware Demands
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Nov 02, 2020 |
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Beware of Audit Hot Spots Highlighted by the CARES Act
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Oct 26, 2020 |
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Stopping the Bleeding: More Cuts Proposed for 340B
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Oct 19, 2020 |
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Has Focus on Length of Stay Run its Course?
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Oct 12, 2020 |
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Telehealth Fraud Bust: Fed Takedown Nets $6 Billion, 345 Defendants
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Oct 05, 2020 |
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CMS Orders Medicare Advantage Organizations to Cease “Pseudo Denials” to Non-contracted Providers
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Sep 28, 2020 |
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An Ominous Forecast: Auditors are Ramping Up Activities
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Sep 21, 2020 |
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The RVU Conundrum: Expect Declines in Operating Income
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Sep 14, 2020 |
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EXCLUSIVE: The Healthcare Algorithms Arms Race is Heating Up
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Aug 31, 2020 |
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Big Pharma versus 340B
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Aug 24, 2020 |
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California Whistleblower Claim Yields $24 Million Abbvie Settlement
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Aug 17, 2020 |
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Exclusive 60-Minute Broadcast: COVID-19 Rules
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Aug 10, 2020 |
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Special Edition: DateLine CMS
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Aug 06, 2020 |
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Defund the UPICs? Auditors Attack Osteopathic Medicine
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Aug 03, 2020 |
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The Virus and the Audits: A Special 60-Minute News Roundup
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Jul 28, 2020 |
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Bagnall to Alexander- finally over? An assessment of Alexander V Azar on healthcare
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Jul 20, 2020 |
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Cash and Lavish Goodies to Bribe Physicians to Prescribe Novartis Drugs: Anatomy of FCA Allegations
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Jul 13, 2020 |
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A Troubling Cornucopia of COVID-Related Fraud
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Jun 29, 2020 |
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Respiratory Failure Denials could become more common, get ready for post-pandemic denials
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Jun 22, 2020 |
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Exclusive: Post-Pandemic COVID-19 Audits and Denials
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Jun 15, 2020 |
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Exclusive: The Intersection of COVID-19 and Inpatient Rehabilitation Facilities
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Jun 08, 2020 |
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Exclusive: COVID-19 and Contact Tracing
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Jun 01, 2020 |
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Exclusive: Mitigating the Uncontrolled Spread of COVID-19: An Epicenter Case Study
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May 18, 2020 |
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Healthcare News Roundup: Special 60-Minute Edition
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May 12, 2020 |
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EXCLUSIVE: COVID-19 Town Hall – $50 Billion Aid Package: Pitfalls and Risks
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May 04, 2020 |
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EXCLUSIVE: A UM Dispatch from the Front Lines of the COVID-19 Pandemic
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Apr 27, 2020 |
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EXCLUSIVE: The COVID-19 Impact on Medicare Appeals
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Apr 20, 2020 |
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EXCLUSIVE: The COVID-19 Impact on Custodial Admissions
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Apr 13, 2020 |
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EXCLUSIVE: Hospitals on the Front Line – A Town Hall Q&A
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Apr 06, 2020 |
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EXCLUSIVE: Monitor Mondays COVID-19 Town Hall Q&A
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Mar 30, 2020 |
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EXCLUSIVE: COVID-19 by the Numbers
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Mar 23, 2020 |
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Converting Medicare Patients from Inpatient to Outpatient and Condition Code 44
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Mar 16, 2020 |
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Exclusive: Big Pharma, Big Money, Big Troubles
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Mar 09, 2020 |
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Hospital Price Transparency: Clearing Up the Compliance Confusion
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Mar 02, 2020 |
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Exclusive: The Plight of Rural Health, Part II
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Feb 24, 2020 |
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Exclusive: The Plight of Rural Health, Part I
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Feb 17, 2020 |
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Exclusive: The AI Arms Race in Medicare Audits
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Feb 10, 2020 |
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War on Drugs: EHR Vendor Admits to Receiving Illegal Kickbacks from Opioid Pharmas
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Feb 03, 2020 |
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Balancing Billing: A Swirling Controversy
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Jan 27, 2020 |
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War on Drugs: Court Orders AmerisourceBergen to Hand Over Opioid-Related Documents to Pension Fund
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Jan 20, 2020 |
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2020: Look Out, Look Ahead
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Jan 13, 2020 |
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Monitor Mondays 10th Anniversary Tribute
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Jan 06, 2020 |
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Home Health and Hospice: State of the Union
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Dec 09, 2019 |
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Rural Health: State of the Union
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Dec 02, 2019 |
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Discharge Planning Conditions of Participation: The IMPACT and Consequences
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Nov 26, 2019 |
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Monitoring Patient Mortality: Compliance and Quality
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Nov 18, 2019 |
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Known by the Company You Keep: Disclosures of Affiliations
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Nov 11, 2019 |
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Anatomy of an Algorithm: Optum Algorithm Under Fire for Alleged Racial Bias
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Nov 04, 2019 |
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CMS Site-Neutral Payments: Hospitals Win, CMS Loses, but the War is Not Over
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Oct 28, 2019 |
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Feds Putting the Squeeze on Medicare and Medicaid Payments: $252.6 Billion in Cuts Reported
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Oct 21, 2019 |
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PDPM: New Reimbursement Model is Driving Disruption
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Oct 14, 2019 |
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340B Drug Program in CMS Crosshairs
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Oct 07, 2019 |
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Developing Story: Virginia Governor and MCOs Sued by Behavioral Health Providers
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Sep 30, 2019 |
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Developing Story: Virginia’s Behavioral Health Providers Under Siege
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Sep 23, 2019 |
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No Time for SNFs: PDPM Becomes Effective Oct. 1
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Sep 16, 2019 |
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RACs and SNFs: Referrals in the Crosshairs
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Sep 09, 2019 |
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Understanding the Rules of Engagement at the ALJ Level
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Aug 26, 2019 |
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Two Suicides and a Bankruptcy: Have Some Auditors Gone Rogue?
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Aug 19, 2019 |
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An Unsolved Mystery: Lifting the Suspension of Medicare Funds
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Aug 12, 2019 |
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Changes in the Works for Home Care Providers
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Aug 05, 2019 |
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Medicare Advantage Plans: Making Up Their Own Rules
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Jul 29, 2019 |
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Auditors Will Target SNF Patient Condition, Not Services and Time Rendered
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Jul 22, 2019 |
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What to Do When a Government Agent Knocks on Your Door
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Jul 15, 2019 |
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The Seema Verma Blog Post That’s Making Providers Anxious
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Jul 08, 2019 |
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340B Drug Survey Reveals Help to Rural Hospitals
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Jul 01, 2019 |
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Yea or Nay? Surprise Balance Billing Legislation Heads for a Vote
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Jun 24, 2019 |
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Responding to Emergency Department Claim Denials
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Jun 17, 2019 |
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A Legend Returns to Monitor Mondays
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Jun 10, 2019 |
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No Surprise: Stakeholders Fight to Solve Surprise Billing
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Jun 03, 2019 |
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340B Dodges Another Bullet
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May 20, 2019 |
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Inpatient versus Outpatient: Status of Psych Patients in the ED
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May 13, 2019 |
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New Proposal for Dual-Eligibility Beneficiaries: Good Intentions or Cost Cutting?
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May 06, 2019 |
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Congressional Action on Surprise Balance Billing
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Apr 29, 2019 |
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ECAPE: Revealing the New Backlog Buster at OMHA
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Apr 22, 2019 |
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Is Disallowing an Appeals Process for a Decrease in Medicare Payments Unconstitutional?
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Apr 15, 2019 |
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Observation and Outpatient Status: Heading for Another Court Fight
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Apr 08, 2019 |
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CMS and Prescription Drug Prices, Part II: 340B State of the Union
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Apr 01, 2019 |
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CMS and Prescription Drug Prices, Part I: 2019 Drug Spending Dashboards
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Mar 25, 2019 |
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Single-Payer Healthcare for New Yorkers: An Option on the Table
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Mar 18, 2019 |
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Removing the Surprise from ED Billing
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Mar 11, 2019 |
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Challenging the Ambiguity of an Agency’s Regulations
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Mar 04, 2019 |
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Forensic Audits: Spurious or Genuine? Part II
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Feb 25, 2019 |
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Forensic Audits: Spurious or Genuine?
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Feb 18, 2019 |
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Is 340B at Risk?
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Feb 11, 2019 |
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Out of Town by Sundown: “Must Be Done by End of Business Day.” Payer-Provider Pressure
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Feb 04, 2019 |
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TKA 2.0: CMS Updates Total Knee Arthroplasty, Again
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Jan 28, 2019 |
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Sepsis-3: Not in New York
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Jan 21, 2019 |
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2019: Look Out, Look Ahead
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Jan 14, 2019 |
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The Dilemma of Sepsis Reporting
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Dec 10, 2018 |
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Dismissal Expected in Providence Health FCA Lawsuit
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Dec 03, 2018 |
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Medicare Advantage Claim Denials: More Egregious, or More Awareness?
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Nov 26, 2018 |
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Court Orders HHS to Clear Medicare Appeals Backlog
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Nov 12, 2018 |
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2019 MPFS and OPPS Final Rules: Where Are We Today
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Nov 05, 2018 |
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Provider-Based Clinics: Major Changes Coming Soon
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Oct 29, 2018 |
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CMS Proposes Changes to Medicare Shared Savings Program: Probing the Impact on Providers
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Oct 22, 2018 |
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Targeted Probe-and-Educate Audits: Three Strikes and You’re Out
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Oct 15, 2018 |
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UnitedHealthcare Puts Sepsis in the Crosshairs
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Oct 08, 2018 |
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CMS Proposes to Implement Home Health Pre-Claim Review Demonstration
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Oct 01, 2018 |
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CMS Proposed Rule Intended to Alleviate Regulatory Burdens: Will it Work?
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Sep 24, 2018 |
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Compliance During Adversity: Hurricane Florence
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Sep 17, 2018 |
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Last Chance to Take a Stand: Comment Period for Proposed E&M Changes Ends
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Sep 10, 2018 |
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Anatomy of an Alleged False Claims Act Violation: The Providence Health & Services Lawsuit
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Aug 27, 2018 |
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CMS, Are You Listening? Podiatrists React Negatively to Proposed E&M Changes
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Aug 20, 2018 |
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Controversy Continues to Swirl Around Proposed E&M Changes
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Aug 13, 2018 |
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2019 Medicare Physician Fee Schedule and the Outpatient Prospective Payment System: Analyzing the Impacts on Providers
|
Aug 06, 2018 |
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Beware: Emerging New Payer Denial for COPD
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Jul 30, 2018 |
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Court Ruling Creates Major Setback for 340B Drug Program
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Jul 23, 2018 |
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Case Management in the ED: Getting Patient Status Right the First Time
|
Jul 16, 2018 |
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The Readmissions Quagmire: Medicaid Work Requirements Pose Audit Risks
|
Jul 09, 2018 |
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Appeal Relief Has Arrived: OMHA Implements Expansion to Settlement Conference Facilitation
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Jun 25, 2018 |
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Pain Points of Pain Management Services
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Jun 18, 2018 |
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340B Drug Discount Program: What Happens Next?
|
Jun 11, 2018 |
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Alleged Bias Found in Extrapolation Audits
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Jun 04, 2018 |
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Total Knee Replacement: The Intersection of Functionality and Care Levels
|
May 21, 2018 |
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Latest News: Feds Delay 340B Enforcement Rules
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May 14, 2018 |
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IPPS Proposed Rule: Major Changes for IRF Providers
|
May 07, 2018 |
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Level of Care Versus Level of Care Billed: An Emerging Audit Problem
|
Apr 30, 2018 |
|
Auditing Non-physician Practitioners
|
Apr 23, 2018 |
|
Facebook: Healthcare’s Social Media Menace
|
Apr 16, 2018 |
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AHA Ordered to Fix the Medicare Appeal Backlog
|
Apr 09, 2018 |
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Telemedicine: Significant Expansion, Followed by a Return to Normalcy
|
Apr 02, 2018 |
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How to Predict the Likelihood of an Audit
|
Mar 26, 2018 |
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Anthem BlueCross BlueShield and UnitedHealthcare: New Worries for Patients and Providers
|
Mar 19, 2018 |
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Medicare and Medicaid RAC Audits: How Auditors Get It Wrong
|
Mar 12, 2018 |
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Quelling the Confusion Over Modifier 25
|
Mar 05, 2018 |
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Time to Junk the Peer-to-Peer Process?
|
Feb 26, 2018 |
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Total Knee or Total Consternation?
|
Feb 19, 2018 |
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EMR and RAC Audits: Who Takes the Hit? Part II
|
Feb 12, 2018 |
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EMR and RAC Audits: Who Takes the Hit?
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Feb 05, 2018 |
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HEDIS Reviews: How to Avoid Payer Abrasion
|
Jan 29, 2018 |
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Medicare Advantage: What’s the Advantage?
|
Jan 22, 2018 |
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2018: Look Out, Look Ahead
|
Jan 15, 2018 |