Monitor Mondays Podcasts

RACmonitor legislative analyst Emily Evans, managing director of healthcare policy for Hedgeye, will return to Monitor Mondays next week to report on the latest news from the Centers for Medicare & Medicaid Services (CMS) that portends a retreat from the expansion of the Advancing Care Coordination through Episode Payment Model – a story first reported on last week by Ronald Hirsch, MD.

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With approval from the Centers for Medicare & Medicaid Services (CMS) in hand, two Recovery Audit Contractors (RACs), Cotiviti and Performant, have a new target in their sights: Condition Code 42.

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During the next edition of Monitor Mondays, whistleblower attorney Mary Inman will return to report on three whistleblowers targeting UnitedHealthcare in Wisconsin. 

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Could off-campus, provider-based clinics and operations be subject to site-neutral payments?

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A North Carolina hospital system recently agreed to pay the federal government $6.5 million to resolve allegations that it violated the False Claims Act by “upcoding” claims for urine drug tests in order to receive higher payment than allowed. At issue were two different payments for two different codes – G0431 and G0434 – and the use of the QW modifier.

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