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Monitor Mondays

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Monitor Mondays

Monitor Mondays

RACmonitor

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About Us

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://event.webcasts.com/starthere.jsp?ei=1235505&tp_key=eae2082467

Latest Episodes

Rural Health: State of the Union

Rural hospitals are an endangered species in America, with extinction a real possibility.

31 MIN2019 DEC 3
Comments
Rural Health: State of the Union

Discharge Planning Conditions of Participation: The IMPACT and Consequences

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.

30 MIN2019 NOV 26
Comments
Discharge Planning Conditions of Participation: The IMPACT and Consequences

Monitoring Patient Mortality: Compliance and Quality

Patient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care.

30 MIN2019 NOV 19
Comments
Monitoring Patient Mortality: Compliance and Quality

Known by the Company You Keep: Disclosures of Affiliations

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.

30 MIN2019 NOV 12
Comments
Known by the Company You Keep: Disclosures of Affiliations

Anatomy of an Algorithm: Optum Algorithm Under Fire for Alleged Racial Bias

Giant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.

32 MIN2019 NOV 5
Comments
Anatomy of an Algorithm: Optum Algorithm Under Fire for Alleged Racial Bias

CMS Site-Neutral Payments: Hospitals Win, CMS Loses, but the War is Not Over

A federal court on Tuesday found that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced payments for hospital outpatient services delivered outside of hospitals in outpatient provider-based settings.

31 MIN2019 OCT 29
Comments
CMS Site-Neutral Payments: Hospitals Win, CMS Loses, but the War is Not Over

Feds Putting the Squeeze on Medicare and Medicaid Payments: $252.6 Billion in Cuts Reported

Acts of Congress plus regulatory cuts by the Centers for Medicare & Medicaid Services (CMS) are estimated to reduce federal payments to hospitals by $256.6 billion from 2010 to 2029, according to a study released this week and commissioned by the American Hospital Association (AHA) and the Federation of American Hospitals.

29 MIN2019 OCT 22
Comments
Feds Putting the Squeeze on Medicare and Medicaid Payments: $252.6 Billion in Cuts Reported

PDPM: New Reimbursement Model is Driving Disruption

There have been recent media reports of layoffs and pay cuts among the ranks of those working in the nation’s skilled nursing facilities (SNFs) as a result of the new Medicare reimbursement model from the Centers for Medicare & Medicaid Services (CMS): the Patient-Driven Payment Model.

31 MIN2019 OCT 15
Comments
PDPM: New Reimbursement Model is Driving Disruption

340B Drug Program in CMS Crosshairs

The Centers for Medicare & Medicaid Services (CMS) reportedly will collect information from hospitals about the prices they pay for drugs through the 340B discount program.

30 MIN2019 OCT 8
Comments
340B Drug Program in CMS Crosshairs

Developing Story: Virginia Governor and MCOs Sued by Behavioral Health Providers

As expected, the Governor of Virginia, Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Wednesday, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.

29 MIN2019 OCT 1
Comments
Developing Story: Virginia Governor and MCOs Sued by Behavioral Health Providers

Latest Episodes

Rural Health: State of the Union

Rural hospitals are an endangered species in America, with extinction a real possibility.

31 MIN2019 DEC 3
Comments
Rural Health: State of the Union

Discharge Planning Conditions of Participation: The IMPACT and Consequences

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.

30 MIN2019 NOV 26
Comments
Discharge Planning Conditions of Participation: The IMPACT and Consequences

Monitoring Patient Mortality: Compliance and Quality

Patient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care.

30 MIN2019 NOV 19
Comments
Monitoring Patient Mortality: Compliance and Quality

Known by the Company You Keep: Disclosures of Affiliations

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.

30 MIN2019 NOV 12
Comments
Known by the Company You Keep: Disclosures of Affiliations

Anatomy of an Algorithm: Optum Algorithm Under Fire for Alleged Racial Bias

Giant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.

32 MIN2019 NOV 5
Comments
Anatomy of an Algorithm: Optum Algorithm Under Fire for Alleged Racial Bias

CMS Site-Neutral Payments: Hospitals Win, CMS Loses, but the War is Not Over

A federal court on Tuesday found that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced payments for hospital outpatient services delivered outside of hospitals in outpatient provider-based settings.

31 MIN2019 OCT 29
Comments
CMS Site-Neutral Payments: Hospitals Win, CMS Loses, but the War is Not Over

Feds Putting the Squeeze on Medicare and Medicaid Payments: $252.6 Billion in Cuts Reported

Acts of Congress plus regulatory cuts by the Centers for Medicare & Medicaid Services (CMS) are estimated to reduce federal payments to hospitals by $256.6 billion from 2010 to 2029, according to a study released this week and commissioned by the American Hospital Association (AHA) and the Federation of American Hospitals.

29 MIN2019 OCT 22
Comments
Feds Putting the Squeeze on Medicare and Medicaid Payments: $252.6 Billion in Cuts Reported

PDPM: New Reimbursement Model is Driving Disruption

There have been recent media reports of layoffs and pay cuts among the ranks of those working in the nation’s skilled nursing facilities (SNFs) as a result of the new Medicare reimbursement model from the Centers for Medicare & Medicaid Services (CMS): the Patient-Driven Payment Model.

31 MIN2019 OCT 15
Comments
PDPM: New Reimbursement Model is Driving Disruption

340B Drug Program in CMS Crosshairs

The Centers for Medicare & Medicaid Services (CMS) reportedly will collect information from hospitals about the prices they pay for drugs through the 340B discount program.

30 MIN2019 OCT 8
Comments
340B Drug Program in CMS Crosshairs

Developing Story: Virginia Governor and MCOs Sued by Behavioral Health Providers

As expected, the Governor of Virginia, Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Wednesday, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.

29 MIN2019 OCT 1
Comments
Developing Story: Virginia Governor and MCOs Sued by Behavioral Health Providers
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