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Monitor Mondays

RACmonitor
Medicare
False Claims Act
Medicaid
Medicare Advantage
CMS
Artificial Intelligence
Telehealth
Healthcare Fraud
340B Drug Pricing Program
Healthcare Compliance
Racmonitor
Medicare Advantage Plans
Healthcare Audits
Affordable Care Act
Health Care Compliance
Centers For Medicare and Medicaid Services
No Surprises Act
Home Health Care
Prior Authorization
Social Determinants Of Health

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: racmonitor.medlearn.com/racmonitor/podcasts/

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Artwork for Monitor Mondays

Latest Episodes

Maureen Testoni, the stalwart president and CEO of the renowned 340B Health Program, will join the long-running Monitor Mondays to

discuss Eli Lilly’s escalating demands for hospitals to submit in-house claims data as a condition of receiving 340B d... more

At the heart of a recent lawsuit filed by a physician is whether the medical profession’s understanding and practice of racial concordance is legally defensible.

“Find-A-Black-Doctor” has served as a platform for Black, Indigenous, and Persons of Co... more

It’s that bright new shiny object few seem to manage to resist: artificial intelligence (AI).

Here at RACmonitor and Monitor Mondays, we have been reporting on how this disruptive technology has been altering the compliance landscape.

And we will c... more

Introducing FOCUS (Fraud Oversight through Careful Use of Statistics).  The U.S. Department of Justice (DOJ) has launched a new initiative in response to the surge in False Claims Act qui tam filings by data miners.

Today, roughly 45 percent of DOJ ... more

Healthcare compliance has entered the machine-learning era, and most organizations have not yet noticed. 

Providers are using artificial intelligence (AI) to generate documentation, surface reimbursable conditions, and tighten coding workflows. Regu... more

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 ... more

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” ... more

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 audi... more

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Recent Guests

Pam Warren
Manager, regulatory billing audit
MaineHealth
Episode: AI and Auditing: Major Compliance Risks
Hamsa Mahendranathan
Whistleblower attorney
Whistleblower Attorney (lead story)
Episode: Surge in False Claims Act Violations Triggers New DOJ Initiative
Ronald Hirsch
Physician advisor/MD
R1 Physician Advisory Solutions
Episode: Surge in False Claims Act Violations Triggers New DOJ Initiative
Folana Houston
Senior Legislative Affairs Analyst
Zelis
Episode: When Algorithms Audit Algorithms
Dr. James S. Kennedy
Lead story presenter on sepsis terminology and ICD-10 updates
Dr. Kennedy (physician)
Episode: Developing Story: Updating Sepsis Terminology in ICD-10-CM
Nicole LaMagna
Health care attorney
(Firm not specified)
Episode: Developing Story: Updating Sepsis Terminology in ICD-10-CM
Dr. John K. Hall
Physician and attorney reporting the lead story
Independent/Medical-Legal expert
Episode: SCOTUS Decision on Colorado “Conversion Therapy” Ban Leaves Much Left to Determine
Nicole Mowen
Healthcare attorney substituting for David Glaser
Fredrikson & Byron
Episode: SCOTUS Decision on Colorado “Conversion Therapy” Ban Leaves Much Left to Determine
Ed Roche
RAC Monitor Investigative Reporter
RAC Monitor
Episode: A Close-Up Look at Healthcare AI “Sherpas”

Hosts

Chuck Buck
Host of Monitor Monday
Ronald Hirsch
MD, healthcare physician advisor; provides Monday rounds and regulatory commentary

Top Education Podcasts

Talking Points

Recent interactions between the hosts and their guests.

Medicare Advantage and Prior Authorizations: The Good. The Bad. The Ugly.
Q: Under the two midnight rule, would you consider the blood pressure check as simply the normal triage process or count it?
The consensus indicated that the blood pressure check prior to midnight does start the two midnight clock.
Reign of Terror: Special Audit Report
Q: What should nurses do in a situation where they suspect patient injuries inflicted by ICE agents?
Nurses should consider the legal responsibilities around reporting such injuries, taking into account confidentiality and state laws regarding abuse reporting.
Docs Take Another Financial Hit
Q: Do you think it's harder to win at the ALJ level than it was five or ten years ago?
Yes, particularly because ALJs are now more likely to have their decisions reversed by the MAC.
Docs Take Another Financial Hit
Q: Last time telehealth was paid retroactively, can we assume that that will happen again or do we know?
Yes, we may expect that.
Providers Appear More Aggressive in Defending Revenue
Q: What do you think about the inaccurate report from the OIG regarding outpatient hospital stays?
David has been assisting a client on an OIG audit, and he highlighted the critical misunderstanding regarding outpatient hospital stays under Medicare rules, emphasizing that it is not permissible to have extended outpatient stays.

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Frequently Asked Questions About Monitor Mondays

What is Monitor Mondays about and what kind of topics does it cover?

The show centers on healthcare regulatory audit news, enforcement actions, and policy developments, with frequent deep dives into CMS rules, Medicare/Medicaid audits, and the impact of technology such as AI on coding and compliance. Regular conversations blend legal analysis, legislative context, and practical guidance for providers, coders, and hospital administrators, often featuring physician advisers, health-care attorneys, and investigative reporters. A notable pattern is the cross-functional mix: regulatory updates, enforcement priorities, and real-world implications for audit readiness, documentation governance, and denial management, making it a valuable resource for staying ahead of evolving compliance requirements.

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Which podcasts are similar to Monitor Mondays?

These podcasts share a similar audience with Monitor Mondays:

1. Talk Ten Tuesdays
2. HBR On Leadership
3. The ACDIS Podcast
4. Becker’s Healthcare Podcast
5. At The Table with Patrick Lencioni

How many episodes of Monitor Mondays are there?

Monitor Mondays launched 8 years ago and published 404 episodes to date. You can find more information about this podcast including rankings, audience demographics and engagement in our podcast database.

How do I contact Monitor Mondays?

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What guests have appeared on Monitor Mondays?

Recent guests on Monitor Mondays include:

1. Pam Warren
2. Hamsa Mahendranathan
3. Ronald Hirsch
4. Folana Houston
5. Dr. James S. Kennedy
6. Nicole LaMagna
7. Dr. John K. Hall
8. Nicole Mowen

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