Monday, November 15, 2021
10-10:30 a.m. EST; 7-7:30 a.m. PST
Season 11, Episode 476

Ronald Hirsch, MD, FACP, CHCQ, Knicole Emanuel Esq., David Glaser, Esq.,
Matthew Albright, Edward M. Roche, PhD, JD, Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Using artificial intelligence (AI), along with an uncanny ability to misinterpret rules, Medicare auditors – specifically, third-party auditors of Medicare Advantage (MA) plans – are ever-ready to pounce on healthcare providers. And too often, it’s like shooting fish in a barrel.

The recent posting of three final rules will give auditors ample opportunity to search for more inadvertent errors on Medicare claims. Last week, as reported by RACmonitor, the Centers for Medicare & Medicaid Services (CMS) posted final rules on the same day for the Medicare Physician Fee Schedule (MPFS), the Outpatient Prospective Payment System (OPPS), and the Home Health Prospective Payment System (HHPPS).

More rules = more audits.

It’ll be the area of focus during the next edition of Monitor Mondays, which will also have the latest national audit news updates from well-respected broadcast consultants, including:

  • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return with another installment of his popular segment.
  • Special Report: RACmonitor investigative reporter Edward M. Roche will continue with the second installment in his three-part series that for the first time is showing how auditors can skew the universe of claims to be audited to their advantage by hiding zero-paid claims.
  • RAC Report: Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.
  • SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.
  • Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.
  • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.

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