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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 auditors. You and your team should be aware of the several so-called healthcare “sherpas” available to interpret vast amounts of AI-generated data, among them Grok 4: an AI-powered chatbot solution developed by Elon Musk’s xAi, which is integrated with the X (formerly Twitter) social network. As we have before, our producers invited RACmonitor Investigative Reporter Edward M. Roche to investigate AI and its sherpas, including Grok 4, during the next edition of the long-running Monitor Mondays Internet broadcast, this coming Monday, April 20, at 10 a.m. EST. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

When the U.S. Supreme Court overturned Chevron deference, it promised to restore judicial independence and limit agency overreach.  But in Medicare administrative proceedings, that promise remains unfulfilled.  Tune in to the next upcoming live edition of Monitor Mondays, when senior healthcare analyst Frank Cohen will report on his surprise when an Administrative Law Judge issued a categorical ruling: Loper Bright simply does not apply to the proceedings of the Office of Medicare Hearings and Appeals (OMHA). Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Dr. Jennifer Weinberg will be making her Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. ·      Legislative Update: Adam Brenman will report on current healthcare legislation.

National Doctor’s Day will bring a double whammy this coming Monday when the venerable Monitor Monday continues its recognition of the occasion with a pair of featured speakers: Drs. Drew Updike and Christopher Boyle. The day of recognition took place on March 30, the date when Eudora Brown would place flowers on the graves of late physicians, starting in 1933. Historians are quick to note that the date also commemorates the first use of anesthesia for surgery. Fast forward to Monday, April 6, 2026: that’s when Drs. Updike and Boyle will not only be recognized for their service by Monitor Mondays, but featured as speakers. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Artificial intelligence (AI) is becoming part of how clinical documentation is reviewed across healthcare, from coding and clinical validation to payer denials and appeals.  In many cases, AI is influencing decisions behind the scenes, even when it is not clearly visible. During the next live edition of the long-running Monitor Monday, the Internet broadcast produced by RACmonitor, Sharon Easterling will explain in simple terms how AI reads the clinical record.  Unlike clinicians, AI does not understand the full story of the patient. Instead, it looks for patterns such as words, phrases, and signals, and uses those patterns to reach a conclusion. Because of this, the same record can lead to different outcomes.  Easterling, RACmonitor and Monitor Monday technology consultant, returns to the broadcast and will use a straightforward way to evaluate decisions so that conclusions remain supported, clear, and defensible, even as AI becomes more involved in the process. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney Amanda Mills will join the broadcast with his trademark segment. ·      Legislative Update: Matthew Albright, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Aetna is just the latest in a long list of healthcare entities to settle False Claims Act (FCA) allegations with a massive settlement. The insurer, one of the nation’s largest, recently agreed to pay $117.7 million to resolve a case involving purportedly inaccurate and untruthful diagnosis codes to increase payments.  That and other recent U.S. Department of Justice (DOJ) actions will take center stage during the next edition of Monitor Mondays, when featured speakers will weigh in on striking recent trends related to such developments. Settlements and judgments under the FCA totaled $6.8 billion in the most recent full fiscal yar, an all-time record, with 84 percent of the recoveries related to matters involving the healthcare industry.  Broadcast segments will also include these instantly recognizable features: •Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  •The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  •Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. •Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Imagine machine learning and natural language processing deployed to audit claims. Today, it’s the new reality. Autonomous coding is dramatically altering the treacherous auditing landscape. So, how can you protect your facility from takebacks? How do you maintain coding excellence to remain compliant? Join this coming Monday, March 16 for the next live edition of the venerable Monitor Mondays Internet broadcast, when senior healthcare analyst Frank Cohen will describe the inner workings of autonomous coding. Cohen will also explain how to survive in today’s unforgiving audit landscape, which has become a habitat for advanced technology. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Cate Brantley, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Healthcare documentation is no longer written for a single audience. Today, the medical record must simultaneously meet federal regulatory requirements and the coverage expectations of individual payers. While these systems often overlap, they originate from different authorities and serve different purposes. One governs compliance and program integrity; the other determines whether services are approved and reimbursed. As prior authorization expands and audit scrutiny intensifies, hospitals are increasingly navigating both systems at once. Understanding the distinction between regulatory documentation standards and payer-driven requirements is becoming essential for aligning clinical workflows, documentation practices, and operational strategy in today’s healthcare environment. During the next live edition of the venerable Monitor Monday, the  live Internet broadcast, senior healthcare consultant Penny Jefferson returns to the broadcast to explain what many today are calling the new face of healthcare. Broadcast segments will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

The Centers for Medicare & Medicaid Services (CMS) has launched a new initiative titled Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH). CRUSH is a sweeping fraud prevention program. In an official news release posted Thursday, CMS reported suspending $5.7 billion in suspected fraudulent Medicare payments, preventing $1.5 billion in DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) billing, revoking more than 5,500 providers’ billing privileges, and denying 122,000 claims that failed medical necessity checks. This latest news, including a nationwide DMEPOS enrollment moratorium and a $259.5 million Medicaid funding deferral, signals a decisive shift toward real-time enforcement. What does CRUSH mean for providers, revenue cycle leaders, and compliance teams? Senior healthcare consultant Penny Jefferson will be the special guest during the next live edition of the long-running news and information national podcast Monitor Mondays. Jefferson, the director of clinical documentation integrity (CDI) services for the University of California Davis Medical Center, will report on this new and developing story. The broadcast will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. Legislative Update: Adam Brenman, senior legislative affairs liaison for Zelis, will report on current healthcare legislation.

Prior authorizations among Medicare Advantage plans have drawn criticism and concern from patients, providers, lawmakers, and regulators. But hospitals and doctors are uniquely positioned to advocate for their patients’ access to and coverage for care. What’s necessary is the need to understand the rules of the process. And Medicare Advantage plans have many of them. During the next live edition of the venerable Monitor Monday, the Internet broadcast, Richelle Marting, a healthcare attorney, and certified coder, will help you understand when and how Medicare Advantage plans can use prior authorizations for the critical protections you need to know to advocate for patient care. Broadcast segments will also include these instantly recognizable features: • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. • The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. • Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. • Legislative Update: Matthew Albright of Zelis, will report on current healthcare legislation.

In a January 28 article, Dr. Ronald Hirsch verified that the Centers for Medicare and Medicaid Services (CMS) “has no problem” with the Aetna Severity Payment policy because it “meets the Two-Midnight Rule.”  However, there is more to consider than compliance with 42 CFR 412.3.  Federal regulations also state Medicare Advantage organizations must comply with Traditional Medicare laws including payment criteria for inpatient admissions at 42 CFR 422.101(b)(2). So the burning question remains: Is CMS disregarding pertinent regulations that could nullify Aetna’s policy? During the next live edition of the venerable Monitor Monday, the Internet broadcast, Cheryl Ericson, senior director of clinical policy and education for the Brundage Group, will address this apparent contradiction. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. ·      Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

It’s raining RACs. The Recovery Auditor Contractors (RACs), together with an alphabet soup of other private and public auditors, are coming down hard on hospitals and physician practices, looking for omissions and errors in submitted claims. Then there are seemingly contradictory rules from the Centers for Medicare & Medicaid Services (CMS). It’s little wonder that providers are treading cautiously as they look to thread the needle of compliance. This coming Monday, the venerable Monitor Mondays broadcast will present a cadre of the sharpest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – just here. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. ·      Legislative Update: Cate Brantley, legislative affairs liaison for Zelis, will report on current healthcare legislation.

There was a time when Relative Value Units (RVUs) felt like a stable currency – something you and others could take to the bank.  That was then. This is now. Then, productivity could be measured, compensation plans could be managed, and economic models could assume relative stability in physician work measurement. Recently, actions by the Centers for Medicare & Medicaid Services (CMS) – culminating in the 2026 Physician Fee Schedule – signal a philosophical shift in how physician work is valued, adjusted, and used as a policy lever. The takeaway is not that RVUs are broken; it is that they are no longer designed to be static.  For more details on this change, the producers of Monitor Mondays have invited senior healthcare analyst Frank Cohen to be the special guest during the next live edition of the venerated Internet broadcast, coming up on Monday, Feb. 2. Broadcast segments will also include these instantly recognizable features: ·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. ·      Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

While many of you were enjoying the holidays, Kaiser Permanente was back in the news. This time, another whistleblower case which resulted in an amazing $556 million settlement to resolve allegations that the giant provider/payer fudged on its Medicare Advantage risk adjustment. Reporting the lead story during the next live edition of Monitor Mondays will be Liz Soltan, a New York-based senior associate at Whistleblower Partners. Soltan is a member of the firm's litigation team who represented Dr. James Taylor in his landmark False Claims Act (FCA) case against Kaiser Permanente which resolved allegations of Medicare Advantage risk adjustment fraud. Soltan also works on a major Medicare Advantage risk adjustment fraud case against UnitedHealth Group on behalf of whistleblower Benjamin Poehling. Broadcast segments will also include these instantly recognizable features:  Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.  Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

The Centers for Medicare & Medicaid Services (CMS) will block hospitals from performing certain interventions that are intended to change a child’s physical appearance to align an asserted sex identity. Reporting the lead story during the next live edition of Monitor Mondays will be independent physician consultant Dr. Drew Updike. More than four weeks since its last news broadcast, Monitor Mondays will return this coming Monday, Jan. 12, with a cadre of the smartest minds in healthcare auditing. You’ll hear auditing news you won’t find anywhere else – except here the RACmonitor. Broadcast segments will also include these instantly recognizable features: Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment. Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Whistleblower attorney Max Volman will return to the next Monitor Monday broadcast to report the latest news about whistleblowers.  As we have learned, often “whistleblowers” are not insiders reporting wrongdoing; they tend to be outside the offending organization. Register now to listen to Max Voldman’s exclusive report. Broadcast segments will also include these instantly recognizable features: ●       Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds.  ●       The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors.  ●       Legislative Update: Adam Brenman, legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action. ●       Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.