Avoiding the Next Claim Denial

Monitor Mondays

Monitor Mondays
Avoiding the Next Claim Denial
Jun 29, 2026 Season 14 Episode 687
John K. Hall | Matthew Albright | Knicole Emanuel | David Glaser | Ronald Hirsch

There’s a method by which providers can avoid the snare of the latest claim denial strategy to garner attention. Much has been written about the Aetna policy for its “severity inpatient payment” element.

Yet almost daily, providers appear to be turning to trusted sources to avoid pitfalls. And that is why the producers of RACmonitor’s Monitor Mondays have invited physician and attorney Dr. John K. Hall to serve as special guest during the next edition of the venerable weekly national podcast.

During this remarkable live Internet broadcast, Dr. Hall will unpack the issues that seem to flummox payers, resulting in a variety of actions, ranging from recoupment to reimbursement at lower levels (i.e. “observation” rates).

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 analyst for Zelis, will report on current healthcare legislation.

Episode Artwork Avoiding the Next Claim Denial 29:01 Episode Artwork Seeking Compliance Across the Revenue Cycle 26:42 Episode Artwork Who will Blink First? 340B Health at Center Stage as Controversy Continues 29:28 Episode Artwork Recent Lawsuit: Racial Concordance in Healthcare Takes Center Stage 33:37 Episode Artwork AI and Auditing: Major Compliance Risks 34:24 Episode Artwork Surge in False Claims Act Violations Triggers New DOJ Initiative 26:06 Episode Artwork When Algorithms Audit Algorithms 28:48 Episode Artwork Developing Story: Updating Sepsis Terminology in ICD-10-CM 29:25 Episode Artwork SCOTUS Decision on Colorado “Conversion Therapy” Ban Leaves Much Left to Determine 25:10 Episode Artwork A Close-Up Look at Healthcare AI “Sherpas” 27:15 Episode Artwork EXCLUSIVE: Huge Loophole Has Insulated Medicare Appeals 30:14 Episode Artwork Medical Double Dose: A Paradox on Doctor’s Day 33:46 Episode Artwork Understanding AI Interpretation in Healthcare 29:39 Episode Artwork Aetna Latest to Acquiesce Amid FCA Allegations 30:40 Episode Artwork Autonomous Coding: A New Reality 26:50 Episode Artwork Lesson Learned: Navigating the Ever-Expanding Scope of Prior Authorization 29:33 Episode Artwork CMS Launches CRUSH: A New Anti-Fraud Program 30:42 Episode Artwork Medicare Advantage and Prior Authorizations: The Good. The Bad. The Ugly. 29:48 Episode Artwork Did CMS Draw the Right Conclusion about Aetna’s Severity Policy? 30:23 Episode Artwork Reign of Terror: Special Audit Report 26:27 Episode Artwork Docs Take Another Financial Hit 30:02 Episode Artwork $556 million False Claims Settlement Rattles Many in Healthcare 30:35 Episode Artwork CMS Blocks Gender Affirmative Care 31:10 Episode Artwork The Whistleblower Update 30:37 Episode Artwork The Fatal Blow: “Statistically Valid Extrapolation” 29:25